ACUTE ABDOMEN

oleh: Dr. Sigit Widodo, Sp. Rad

Bagian RadiologiFK. Universitas TrisaktiJ a k a r t a 2 0 0 7

ACUTE ABDOMENFoto abdomen 3 posisi (supine,LLD,setengah duduk)I.1.Ileus USUS HALUSCoiled Spring AppearanceHerring Bone SignFluid levelStep Ladder Pattern

2.Ileus Usus Besar (Colon)a.Ileocaecal Valve Competent*Colon dilatasi*Usus halus tidak ada kelainanb.Ileocaecalvalve In-Competent*Colon tidak disfensi*Usus halus distensiVolvulus sigmoid*Distensi ahaustal*Sigmoid ~U terbalik

II.PERFORASI*Free air sickle(SUBDIAPHRAGMA)

III.PERTITONITISProperitoneal fat hilangDinding usus halus > tebal

PNEUMOPERITONEUMPneumoperitoneum.Erect chest film.Free intra-abdominal gas is clearly demonstrated under the right hemidiaphragm. Under the left hemidiaphragm a small triangular collection of the free gas can be identified between loops of gas-filled bowel ( arrow)

PNEUMOPERITONEUM Pneumoperitoneum. Abdomen supine, a triangular collection of free gas is demonstrated in the subhepatic region (arrows).The falciform ligament is also outline (arrowheads)

Pneumoperitoneum.Abdomen supine.Visualization of both sides of the bowel wall (Riglers sign).Both the inside and outside wall multiple loops of small bowel can be identified clearly

P E R F O R A S IPENYEBAB :AppendicitisTyphoid FeverUlcus Pepticum-Ulcus Ventriculi-Ulcus DuodeniGAMBARAN RADIOLOGI :Pneumo Peritoneum (Udara / gas bebas)

Sigmoid volvulusSigmoid volvulus. Supine film.The hugely dilated ahaustral loop of sigmoid can be seen rising out of the pelvis in the shape of an iverted U. Haustrated ascending and descending colon can be identified separate from the volved sigmoid loop

PARALYTIC ILEUSParalysis ileus. Supine film.There is generalized dilatation of both small and large bowel. An 84-year-old woman with generalized peritonitis perforation of gastric-ulcer

Large Bowel ObstructionLarge bowel obstruction. Type IA (competent ileocecal valve). Supine film. There is gaseous distention of the large bowel from the sigmoid backwards, including the ascending colon and caecum. The dilated caecum lies in the pelvis. There is no visible small-bowel distention

O E S O P H A G U S

MODALITAS PEMERIKSAAN RADIOLOGIRadiologi Polos :a.Thorax AP (Oesophagus)Polos Abdomen (gaster, usus halus, usus besar)Radiografi Kontras (BARIUM)Oesophagus. Gaster duodenum,usus halus, usus besarCT-ScanUSG (Hepar, Tr.Biliaris,Pancreas)

O E S O P H A G U SANATOMI :Phrenic ampula :-Tepat di atas diaphragma- Panjang : 3 5 cm, 2 4 cmCardiac Antrum = esophageal Vestibula-Terletak Intra abdominal- Bilia keluar di atas diaphragma Sliding Hernia3.Schatski Ring :Kontraksi Sphincter Oesophagi Inferior

Penyempitan di 3 :a.Setinggi Os.CricoidCorpusb.Menyilang Bronchus kiriAlienumc.Masuk diaphragmaVena:a.Distal : V.Coronaria Ventriculi V.Porta (Cir.Hepatis Varices)b.Proximal : V.Azygos V.Cava Sup

Kelainan-kelainan pada OesophagusKongenitalRadangTumor JinakGanasGangguan NeuromuskularSebab sebab lain :-Ulcus-Varices

K O N G E N I T A LAtresia OesophagusStenosis OesophagusDivertikelAdditional Deffect4. Double Oesophagus

ATRESSIA OESOPHAGUSRadiograph demonstrating a common type of esophageal atresia in association with a tracheosophageal fistula.In this instance the atressia occurred in the middle one-third sector of the oesophagus communicates with the tracehobronchial tree near its bifurcation

D I V E R T I K E L

Radang OesophagitisEtiologi :- Trauma (Indwelling Tube)- Bakteri : TBC , Lues- Jamur- Rangsangan berulang Makanan PanasOesophagogram :- Akut : (-)- Kronis : Lumen sempit, mucosa irreguler

PEPTIC OESOPHAGITIS.Comparisson of normal mucosaA.With severe ulcerative peptic oesophagitis

T U M O RJinakPolyp,Lipoma,Myoma* Ro : FILLING DEFECT,Batas tegasGanas Carcinoma*Ro :Papillary : Filling Defect,batas tegasUlcerating : Filling Defect, di dalamnya additional defectInfiltrating : Lumen sempit,dinding irreguler

Tumor :JinakGanas -Primer-Sekunder

TUMOR JINAKJenis : Adenoma Polyp Villous Papillomo Hamartoma = Peuts Jager SyndromRo: Filling Defect, batas tegas

SQUAMOUS CARCINOMA OF THE OESOPHAGUSa.Shallow ulcer with tumor rimb.Small filling defect resembelling an intramural lesion

Ca. OesophagusCarcinoma in the lower portion of the middle one-third of the oesophagus, in association with dilatation above the level of the carcinoma,indicating partial obstructionCarcinoma of the lower one-half of the oesophagus showing fistulous communication with the mediastinum due to an invasion of the mediastinum by the carcinoma

ACHALASIA = MEGA OESOPHAGUS =CARDIOSPASMSpasme di hiatus Obstruksi,dilatasi,elongasi,hipertrofi oesophagusTerjadi : setiap umurEtiologi : ??-Neuromuskular incordination-Degenerasi plexus

Ro :Tapering bagian bawah oesophagus obstruksiDilatasi bagian atas Tipe :1.Sigmoid2.Fusiform

Achalasia with typical tapered of the lower end of the oesophagus producing obstruction. On fluoroscopy the impaired motility will be evident. Insufficient barium has entered the stomach to distend it

Achalasia OesophagusRadiograph demonstrating the esophagus in achalasia.Note the fusiform tapered distal end of the esophagus and the redudancy and dilatation of the esophagus above this levelA spot film study of the lower esophagus in the same patient, showing the tapered effect in greater detail

GANGGUAN NEUROMUSKULERSpasmeRo : Lumen sempitFluoroscopy : Peristaltik 2.Ripple oesophagusCork Screw / curlingRo :- Saw tooth appearance- Serrated3.Achalasia ( Cardiospasm)

SEBAB-SEBAB LAINVarices*Etiologi : Cirrosis hepatis hipertensi portal*RO : Mocosa terputus-putus:a.Cincin halus ( Honey comb app)b.Cincin kasar ( Cobble Stone app)2.Ulcus oesophagi *Ro : Additional defect3.Hernia oesophagi

Varices OesophagusSpot film radiographic studies of the lower one-third of the esophagus with demonstration of marked esophageal varicesEsphagogram demonstrating large indicatins due to esophageal varices

Oesophageal varices.Typical worm-like feeling defectsA.Non-distended oesophagus following passage of bariumB.Same case with barium

PEMERIKSAAN GASTER DAN DUODENUM (MD)I.Polos : posisi tegak / supineUntuk : -stenosis pylorus- Atressia duodeniII.KontrastA.Single contrast Barium sulfat ( 1 : 2-3 (air))B.Double contrastBarium sulfat (positif)Udara (negatif)1.sonde / catheter2.Tablet effervescent

Posisi :Tegak SupineProneFoto :1.Overail view2.SpotPersiapan : puasa 4-6 jam

Ruggal Pattern

Kelainan - KelainanI.KONGENITAL :Hypertrophic pyloric obstructionAtressia duodeniII.RADANG :Gastritis : atrophicChronica : Hypertrophic

III.TUMORJinak (adenoma,fibroma,polip)Ganas ( CA)IV.ULCUS PEPTICUMUlcus ventriculiUlcus duodeniV.LAIN-LAIN :Prolaps pylorusVolvulus

D U O D E N I T I SRadiograph demonstrating the widened, irregular rugal pattern of the duodenal bulb associated with duodenitis

G A S T R I T I SDEFINISI :Aneka ragam kondisi yang menimpa mucosa,hanya sebagian karena radang Kebingungan terjadi karena hubungan yang tidak menentu antara klinis, radiologi, endoskopi dan histologi, terutama yang kronik

ACUTE GASTRITISAcute erosive (Hemoraghic) gastritis karateristik : oedema dan erosi mucosaPenyebab :Stress, trauma, analgesic, steroid, alkohol, virus, bile refluxKlinis : Sangat variasi : asimptomatik , dengan nyeri perut, anorema, BB yang tidak dapat diterangkan

Radiologis : 1.Complete : target lesion / bulls eye lesionSmall central spot barium dikelilingi Translucent halo2.Incomplete : > sulit oleh karena tidak ada translucent halo

CHRONIC GASTRITISCHRONIC ATROPHIC GASTRITIS*Radiologis :Area gastrica besar IrrgularArea tanpa area gastrica*Diagnosis sensitif : endoskopi dan biopsi

2.CHRONIC HYPERTOPHIC GASTRITISRadiologis :Mucosal fold thickening dan tortuosity ( Hyperugosity), Normal : sangat variasi !!,>0,5 cmAbnormal : antrum fundus, curvatura major > 1,5 cm

Erosive GastritisA. Numerous erosions are present in the stomach, best seen in two rows in the antrum. Each erosion consist of a small central collection of barium surrounded by transluccent ring ( a small target lesion). By definition these are complete erosions. B. Prominent areae gastricae with several small incomplete erosions (two of the erosions are indicated with arrows).

Antral GastritisA. Two thickened nodular mucosal folds are present (arrowed) and the antrum is conical. The mucosa in the duodenal cap is also thickened (duodenitis). B. Severe antral gastritis. The normal antral mucosa is replaced by a mass of thickened nodular mucosal folds. Conical narrowing of the antrum completely obliterates the normal distal shoulders.

ULCUS PEPTICUMLokasi :70% duodenum30% gasterUlcus duodeniLokasi : 90 % bulbus4 % Post Bulbar1 % distal : 75 % : 25 %Single : 80 %, Multiple : 20 %

Ro :Ulcus niche / crater terutama DD posteriorDeformity bulbusMucosa :-Dasar ulcus duodenum-Sekitar ulcus radiating

Ulcus ventriculi 90 % dapat ditunjukkan RoRo :Ulcus niche / craterGaris radiolucent pada dasar ulcus :1-2 mm garis hamptonBarium fleck dengan jari-jari seperti roda pedati = cart wheelKontralateral dari ulcus ada kontrast (incisura)

DD /Ulcus benignaCepat sembuhMucosa sekitar ulcus regulerUlcus ventrikuli disertai ulcus duodeniDalamnya > lebarnyaTidak pernah di curvatura majorDi sekitar ulcus oedematousKontralateral : kontraksi

Ulcus malignaLamaIrregulerBiasanya singleLebarnya > dalamnyaUlcus di curvatura major selalu malignaDi sekitar ulcus kaku (rigid)--

Ulkus Gaster - Benign & MalignantComparison of benign and malignant lesser-curvature gastric ulcers. A. Benign ulcer projecting, smooth base, radiating folds to ulcer brim. B. Malignant ulcer projecting (uncommon), irregular base, absence of clearly defined ulcer brim, absence of radiating folds to brim, loss of normal mucosal surface to area around ulcer.

Ulkus Gaster - BenignBenign gaster ulcer on the greater curvature (sump ulcer). This ulcer is typical of those occuring in patients who are taking tablets which produce contact iiritation and damage to the gastric mucosa (e. g., nonsteroidal anti-inflammatory drugs, steroid, potassium chloride).

Ulkus gasterRadiograph illustrating incisura opposite a gastric ulcer (Dark arrow, incisura : while arrow, lesser curvature ulcer)

TUMOR GASTER1.Benigna (Polip, papiloma, fibroma,adenoma)2.Maligna ( carcinoma)Poliposis :Ro :Filling defect,batas tegasMobilePeristaltik masih baikBentuk lambung masih normal

CA Gaster : = 3 : 1Umur : 40 70 tahun40 50 % Ca Traktus Gastro IntestinalisPatologisExophytic : a.Fungating b.PolipoidInfiltrativeUlceratif ( di bagian yang nekrotik)

Lokasi : - 70% pylorus - 20% corpus - 8 % CardiaRo : Sangat bervariasi tergantung dari ukuran, lokasi, morfologiFilling defect : polipoid / fungating,single/multipleInfiltratif : dinding irreguler, rigid, peristaltik lokal (-)UlcerasiInfiltrasi yang luas gaster mengkerut + rigid LINITIS PLASTICA

Gastric CarcinomaEarly gastric carcinoma: mixed types. A. An elevated tumour (between) the black arrowheads) is outlined by barium. Two small irregular ulcers are present (white arrows). B. The Tumour comprise a group of nodules and several small irregular areas of ulceration (arrowed). The mucosal folds (on either side of the vertical white line) are amputated at their lower ends.

ATROPHIC GASTERA.Relatively hypotonic stomach with thin-walled fundus and absent rugal pattern in fundus,B.Smooth greater curvature and sluggish peristaltis, C.Speckled appearance of the barium, suggesting flocculatin in gastric mucosa,D.Crumpled paper appearance of the rugae near the cardia,E.Bald,thin,speckled fundus with crumpled paper pattern also

USUS HALUSPemeriksaan :Abdomen polosKontras : Ba Follow troughI.Lanjutan Pemeriksaan lambung duodenum- 2 gelas barium sekaligussebagian-sebagianFluoroscopy : s/d Ileum terminalisII.PEMERIKSAAN SENDIRISelang karet / plastik s/d pylorus masukkan barium

Ba Follow ThroughTujuan:Kelainan intriksikKelainan ekstrinsika.DekatUsus halus b.Jauh

INDIKASI :Anemia yang tidak diketahui kausaDiare yang persistenNyeri abdomenMass abdomen yang palpabelGas dan cairan banyak di usus halusKehilangan protein yang banyakLaboratoris : MALABSORBTION

KONTRAINDIKASIObstruksi ususPerforasi ususIleus paralitikPeritonitisInfeksi akut saluran cerna

KELAINAN PADA USUS HALUSObstruksi ileusInflamasi kronik / granulomatosisa.Crohns diseaseb.TBC usus halusMalabsorption syndromeTumorDiverticleGangguan vaskulerPenyakit endokrin (Zollinger Ellison Disease)Penyakit penyakit parasit

CROHNS DISEASE = REGIONAL ILEITIS = REGIONAL ENTERITIS = Semua umur,tersering 15-30 th.Jarang < 4 thLokasi : 85 % di usus halus Ileum distalKlinis :Gejala obstruksiAnemia dengan kausa ?Occult Blood di feces3.Malabsorbtion Syndrome

Ro :Fase akut :Mucosa oedema dinding usus menebalCobble stone appLumen normalFase kronik :Fibrosis obstruksi,dinding striktur, kaku (rigid), gambaran mukosa (-)Hose pipe app : lumen sempit,elongatio, skip area (ada area yang sehat)String signScattering dan clumping

Crohns DiseaseCrohns disease. The iiregular loops demonstrate an ulceronoudular appearance

Crohns DiseaseThe follow-through shows scaterred areas of ulceration and narrowing, with almost normal appearance in the terminal ileum

Crohns DiseaseNumerous narrowed areas are seen, with fold thickening and pseudosacculation on the antimesentric margin.

REGIONAL ENTERITISCoarsened rugal pattern of the distal ileum producing a cobblestone appearance.

REGIONAL ENTERITISSegmentation or clumping of the small intestines as found in a patient with regional enteritis. It will also be noted, however, that there is a complete distruption of the normal mucosal pattern with evidence of ulceration in the distal ileumScattering of barium in small intestines. This was a patient with regional enteritis, there is evidence of distruption of mucosal pattern, some evidence of clumping, and loss of normal mucosal pattern

REGIONAL ENTERITISA.Regional enteritis of the small intestine. Thhe white arrow points to a moulage sign, whereas the dark arrow points to a fistulation between two loops of small intestines.There is an additional fistula between the ileum and sigmoid colon.B,Regional enteritis with the fistula formation between jejenum and sigmoid colonUlceration and sawtoothing in the distal ileum in a patient with regional enteritis

TUMOR USUS HALUSInsidens : sangat jarangKlasifikasi :1.Jinak2.GanasTUMOR JINAKJenis :LeiomyomaAdenomaLipoma,hemangiomaRo : Filling defect dengan batas tegas dan rata

TUMOR GANASCarcinoidRo :Polypoid filling defect single / multipleMass filling defectAdeno CaRo :Filling defectLumen irregulerDinding kakuKhas kalsifikasi (PSAMOMA)

C O L O NPanjang : 5 5,5 kaki (150-160 cm)Diameter : 5 7,5 cmBagian :CaecumColon ascendensColon transversumColon descendensColon sigmoidColon rectum

COLON INLOOP= BARIUM INLOOP= BARIUM ENEMAPersiapan:Harus baik colon bersih / kosong :Makan bubur kecap 1 hari sebelumnya10 -12 jam sebelumnya : laxans garam inggris ( 30 gr)Dulcolax tab / supp3.Puasa

Kontras : Barium * Single contrast (SC)* Double contrast (DC)Single contrast :Barium :Bubuk : air = 1 : 4 ,hangat - 1 LMengisi colon dengan gaya berat : standard 1 meter ( tidak lebih) s/ d Ileum terminalis

Double contrastTeknis > sukar daripada single contrastTahapan :Pengisian s/d Flexura LienalisPelapisan : 1-2 menitPengosongan : miringkan (left decubitus) dan tegakkan (Upright)PengembanganFoto : spot viewoverall viewKomplikasi : 1.Perforasi 2.Reflex vagal X sulfas atropin, 02

COLON INLOOP DOUBLE CONTRASTMengubah pola makanan : lunak, rendah serat,rendah lemakMinum sebanyak-banyaknya :penyerapan air terbanyak di colon feces lembekPencahar : usia lanjut, rawat baring lama, sembelit kronikBanyak bergerak, jangan merokok

FOTO COLON INLOOPPlain = polosFull filling :A.SpotB.Overall3.Post evakuasi

COLON INLOOPINDIKASI :Kongenital HirschprungsInflamasi kronikDiare persitentPerdarahan per anumTumorObstruksi colon InvaginasiVolvulus

KONTRAINDIKASI :Ileus paralitikPerforasi usus / lambungObstruksi ileus yang lama (> 8 jam)PeritonitisInflamasi akut G.I.T

C O L O NRadiograph of the colon after evacuation of barium

KELAINAN KONGENITALI.ATRESSIA ANI = IMPERFORATE ANUSRo : posisi RICE WANGENSTEIN = pasien dibalik : kepala di bawah,daerah anus diberi marker ditentukan jarak (udara s/d marker)

ATRESIA RECTUMProne cross-table lateral view showing a high rectal atresia. The arrow points to the uppermost air shadow and the site of the atresia

II.Hirschprung disease = Megacolon congenitalInsidens : anak-anak : Klinis : Obstipasi, perut kembung / besarRo : Penyempitan lumen yang aganglionik

HIRSCHPRUNGShort-segment Hirschprungs disease. The distal narrowed segment is arrowed

C O L I T I SI.NON SPESIFIKColitis ulcerativaCrohns diseaseIschamic colitis

II.SPESIFIKColitis TBC

COLITIS TBCLokasi : 1.Ileocecal ( 90%)2.Kadang-kadang meluas3.AppendixInsidens :- 30% atau lebih pada KP- Jarang primer

Ro :Teknik : 1.Barium follow through 2.Barium EnemaTanda-tanda :HypermortilityIrregular ileocecal filling defectSpasme Regio ileocecalPlastic peritonitisSegmentation,dilatation,stasis di ileal loopsSTIERLINS SIGN :Ileum dan colon transversum terisi barium, tetapi caecum dan colon ascendens tidak terisi

COLITIS TBCTuberculosis. There is a short irregular stricture in the ascending colon

COLITIS ULCERATIVAKlinis :Umur 20-40 tahun, : Patologi : infeksi akut ulcerasi mucosa, dinding usus terkena difus fibrosis, kontraksi

Ro:Haustra hiloang, spasme, irritability, saw tooth Colon transversumPost evakuasi : String sign = Hose pipe Ulcer craterIleocecal terbuka (patent) , DD/TBCColon transversum : kontraksi,memendek dan lumen menyempitCaecum : kontraksi irreguler, mucosa MARBLE

COLITIS ULCERATIVAA.B.Ulcerative colitis, showing a fine granularity throughout the colon, which is shortened and totally devoid of haustration

COLITIS ULCERATIVAUlcerative colitis.Coarse granularity

COLITIS AMUBALokasi : -Ileocaecal-Colon ascendens-Rectum sigmoidPatologi : Ulcerasi fibrosis adhesi annular ConstrictionRo: Mula-mula (-)Progress : segmenting haustra di cecum dan colon ascendens cicatrixPemendekkan dan penyempitanSaw toothTidak patognomonis

CARCINOMA COLONLokasi : - kasus sigmoid, rectum, recto sigmoid, jarang multiplePatologi : Adeno Ca (50-75 %) Fibro Ca (20%)Metastasis : hepar, regional lymphnodeRo :Polypoid Bertangkai (Pedunculated)

Ro :Polypoid Bertangkai (Pedunculated)(23%)Tidak bertangkai (sessile)2.Fungating = apple score (asimetris)3.Annular = napkin ring ( simetris) (75%)

Carcinoma ColonA large proliferative carcinoma of the ascending colon (arrows)

Carcinoma ColonA classic annular carcinoma (arrow)

Ca Colon

DIVERTICULA COLON : = 2 : 1Umur > 40 tahunLokasi : sigmoid, colon descendensKeluhan : -Perdarahan -Bila terinfeksiRo : ADDITIONAL DEFECT

VOLVULUSDEFINISI : Mesenterium Colon berputar pada axisnya Strangulasi (hambatan sirkulasi)Lokasi : Sigmoid (75%)CaecumPredisposisi :Sigmoid terlalu panjangFecal stasisMegacolonInsidens : : = 2 : 1 20 50 tahun

Ro :I.Polos :1.Dilatasi colonIleus2.Fluid levelObstruksi3.U terbalik di hipochondria kiriII.Colon inloop :Barium stopDilatasi hebat colon proximalBarium sebagian dapat melewati penyempitan ~ Kipas (fan Share)

VOLVULUS RECTARadiograph demonstrating volvulus of the cecum

INVAGINASI = INTUSSUGCEPTIONDEFINISI : Usus proximal masuk ke dalam usus distalProximal IntussusceptumDistal IntussuspiensTIPE :IleoilealIleocolicColocolic

Insidens : anak-anak oleh karena perubahan pola makanan : cair padatGejala :Sakit perut mendadak sekitar pusatPerdarahan peranumTeraba massa di sekitar pusatDiagnosis :Colon in loop (< 10 jam)Kamar operasiJuga untuk terapi

IRRITABLE COLON SYNDROME = COLON SPASMDefinisi : Spasm ColonEtiologi :PsikologisReflexKeracunan (Pb)Inflamasi lokalIdiopatik

Lokasi : 1.Colon Descendens2.Colon sigmoidRo :Lumen sempitHaustra hilangMucosa rataBila mengenai sebagian besar colon Ribbon-Like Structure (~ Pita / pipa)

NECROSTISING ENTERO COLITIS ( NEC )

Sering terjadi pada bayi premature,yang mengalami tambahan stress.

Ini berhubungan dengan respiratory distress, passage umbilical catheter, obstruksi intestinal (terutama penyakit Hirschsprung) atau setelah pembedahan.

Breast feeding tampaknya memberi semacam proteksi, di duga stress mengakibatkan ischaemi dinding usus dengan mekanisme reflex.

Ini mengakibatkan necrosis mucosa dan prolifersi organisme pathogen.

Biasanya permulaannya dalam 2-5 hari bayi menjadi sakit, muntah-muntah dan sering terjadi perdarahan rectal serta distensi abdomen.

Foto polos abdomen menunjukkan distensi usus, pada fase awal terutama pada kwadran kanan bawah.

Kemudian tampak gelembung-gelembung di caecumini harus dibedakan dengan meconium ileus.

Gambaran klinik dan umur dapat membantu untuk membedakannya. Kemudian timbul gas di dinding usus dan dapat dikenal sebagai longitudinal translucent streaks atau sebagai cincintransluency bila usus terlihat end on.

NEC dapat menyerang setiap bagian usus, tetapi terutama menyerang ileum terminalis dan colon.

Dan gas dapat dilihat dengan jelas pada dinding colon. Gambaran ini harus dibedakan dengan garis properitonea fat. Diagnosis yang pasti dapat dibuat pada stadium ini. Gas dapat di lihat pada sistem portal, suatu tanda kegawatan.

Tanda tanda kegawatan lain adalah unchanging loop, karena ini meliputi gangrene, ascites, oedema dinding abdomen dan perforasi usus.

Yang tersebut terakhir ini dapat tanpa gejala (asymptomatic) maka pada prakteknya dibuat foto supine dan lateral setiap 6 jam pada fase akut.

Karena bahaya perforasi colon, maka dihindari pemeriksaan dengan kontras (colon inloop).

Sering terjadi stricture hanya setelah 3 - 4 minggu. Pada fase ini pemeriksaan dengan kontrs perlu dilakukan dan aman.

Harus diingat beberapa egen yang sempit dapat di sebabkan oleh temporary spasm, bukan oleh permanent firous stricture.

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