RUPTUR SPONTAN DINDING REKTOSIGMOID USUS DENGAN LESI ENDOMETRIOSIS SUSUPAN DALAM, PASCA PEMBERIAN DIENOGEST UNTUK DUGAAN KISTA ENDOMETRIOSIS OVARIUM BILATERAL

• Adi Widodo

  Author

• Utomo Budidarmo

  Author

• Elizabeth Feloni

  Author

abstrak 

Pendahuluan: Endometriosis merupakan penyakit ginekologi pada 6-10% wanita usia reproduksi. Berdasarkan presentasi klinis, endometriosis dapat dibagi menjadi endometriosis peritoneal atau superfisial, endometrioma ovarium, dan deep infiltrating endometriosis (DIE). Deep infiltrating endometriosis didapatkan pada 20% kasus endometriosis. Sebanyak 90% kasus DIE berlokasi di intestinal melibatkan regio rektosigmoid, diikuti dengan regio appendiks, dan ileum terminalis. Berikut laporan kasus DIE dengan ruptur dinding rektosigmoid.

Laporan kasus: Seorang wanita 44 tahun dengan keluhan nyeri perut regio epigastrik dan hipogastrik yang memberat sejak 1 hari sebelum masuk rumah sakit. Diketahui wanita ini menderita dugaan kista endometriosis dari pemeriksaan sebelumnya dan telah diberikan dienogest tablet 2 mg perhari selama 6 hari sebelumnya. Pemeriksan USG sesuai dengan kista endometriosis bilateral, selanjutnya direncanakan tindakan laparotomi histerektomi total salpingooforektomi bilateral. Intraoperatif ditemukan massa kistik ovarium bilateral diduga kista endometriosis dan dilakukan histerektomi salpingooforektomi bilateral serta pengangkatan lesi/implant endometriosis semaksimal mungkin, serta adanya ruptur spontan pada segmen rektosigmoid usus yang terdapat dugaan lesi/implant endometriosis susupan dalam, dilakukan reseksi segmen usus tersebut dan dilanjutkan repair dan kolostomi.

Diskusi: Kejadian perforasi spontan pada endometriosis usus , baik pada rektosigmoid, ileus pada perempuan yang tidak hamil sangatlah jarang, penyebabnya belum diketahui pasti. Hingga saat ini, tatalaksana DIE masih menjadi tantangan bagi klinisi. Prinsip terapi endometriosis adalah mengeliminasi lesi, nyeri, memperbaiki fertilitas, dan mereduksi serta menghindari rekurensi. Terapi farmakologi lini pertama pada kasus endometriosis merupakan pemberian progestin. Sampai saat ini belum ada standar pembedahan yang direkomendasikan untuk kasus endometriosis rektosigmoid.

Kesimpulan: Kasus ruptur rektosigmoid pada kasus DIE dapat terjadi dan memerlukan penanganan multidisiplin mulai dari diagnostik hingga kuratif dan preventif.

abstract 

Introduction: Endometriosis is a gynecological disease in 6-10% of women of reproductive age. Based on clinical presentation, endometriosis can be divided into peritoneal or superficial endometriosis, ovarian endometrioma, and deep infiltrating endometriosis (DIE). Deep infiltrating endometriosis is found in 20% of endometriosis cases. As many as 90% of DIE cases are located in the intestine involving the rectosigmoid region, followed by the appendix region and the terminal ileum. The following is a case report of DIE with rectosigmoid wall rupture.

Case Ilustration: Female 44 yo with worsening of severe pain at epigastric and hypogastric area since 1 day before admission. The pain initially felt since 6 weeks prior to admission. She had been known to have bilateral endometriosis cysts from prior examination and was given dienogest 2 mg for 6 days for the condition. Ultrasound examination revealed suspected bilateral endometriosis cysts, subsequently was then planned for laparotomy total abdominal hysterectomy bilateral salpingoophorectomy. During the surgery, two endometriotic ovarian cysts was found followed by total abdominal hysterectomy bilateral salpingooophorectomies and optimal excisions of remaining eendometriotic implants, also there was what appear to be spontaneous rupture on the rectosigmoid portion of the bowel complicated with Deep infiltrating Endometriosis on its wall, subsequently segmental resection of the bowel, repair and colostomy was performed. 

Discussion: The incidence of spontaneous perforation in intestinal endometriosis, both rectosigmoid, ileus in non- pregnant women is very rare, the cause is not yet known for certain. Until now, the management of DIE is still a challenge for clinicians. The principles of endometriosis therapy are to eliminate lesions, pain, improve fertility, and reduce and avoid recurrence. The first line of pharmacological therapy in cases of endometriosis is administration of progestin. Until now there is no recommended surgical standard for cases of rectosigmoid endometriosis.

Conclusion: Cases of rectosigmoid rupture in DIE can occur and require multidisciplinary management from diagnostic to curative and preventive.

1. Adi Widodo

   RS Bhayangkara Tk.1 Pusdokkes Polri, Jakarta

2. Utomo Budidarmo

   RS Bhayangkara Tk.1 Pusdokkes Polri, Jakarta

3. Elizabeth Feloni

   RS Bhayangkara Tk.1 Pusdokkes Polri, Jakarta

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