Fisura Ani
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![Page 1: Fisura Ani](https://reader033.fdocument.pub/reader033/viewer/2022061415/5572111a497959fc0b8e57d2/html5/thumbnails/1.jpg)
FISURA ANI
Bedah DigestifFK Udayana/RSUP Sanglah
2012
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Anatomi Anal Kanal
• Panjang 4-5 cm• Dentate line: batas
mukosa dari embrionik endoderm dan ektoderm
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Definisi
suatu robekan dalam anoderma distal terhadap dentate line
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Penyebab Fisura Ani
• defekasi feses yang besar dan keras, • trauma pada saat kelahiran, • diare kronis, • trauma akibat insersi pada anus, • alergi makanan, • kebiasaan menahan defekasi yang lama
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Epidemiologi
• lebih banyak terjadi pada wanita • 87% terjadi pada usia antara 20-40 tahun• Location: midline (pria: 99% posterior,
wanita: 90% posterior
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Patofisiologi
• resting pressure dalam anal kanal:– 55% spinter anal internus– 30% spinter anal eksternus – 15% bantalan pada anus dan mukosa
• Etiologic factors peningkatan ARP hipoperfusi laserasi, menghambat proses penyembuhan
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Patofisiologi
• NYERI• CIRCULUS VITIOSUS. laserasi spasme
dari sfingter ani internus nyeri hebat + peningkatan laserasi + hipoperfusi menahan BAB feses keras laserasi makin luas
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Klinis• Nyeri saat defekasi ameliorates in
between def. periods• Innocuous bleeding• Peradangan perianal abses fistula4
• AKUT: pertama kali, sembuh dalam hari-minggu
• KRONIS: berulang, penebalan daerah tepi sekitar luka, pembentukan skin, hipertrofi papilla
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Diagnosis
• Anamnesis• Pem fisik
– Inspeksi– Rectal toucher
(DDx hemorrhoids)
• Anoscopy
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Pengobatan
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Prognosis
• Dapat sembuh sendiri pada fase akut + tanpa komplikasi
• Berkembang menjadi fisura ani kronis
• Surgery: 95% sembuh, 5-15% mengaami inkotinensia, 10% rekurensi
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