DIFFICULT HELLER MYOTOMY DUE TO PROMINENT LARGE LEFT LIVER LOBE
DOI:
https://doi.org/10.31004/prepotif.v8i3.35276Keywords:
Dor Fundoplication, Esophageal Achalasia, Heller MiotomyAbstract
Achalasia Esofagus adalah gangguan motilitas esofagus yang ditandai dengan kegagalan peristaltik dan ketidakmampuan sfingter esofagus bagian bawah (LES) untuk relaksasi. Hal ini disebabkan oleh degenerasi pleksus saraf mienterikus pada dinding esofagus. Dalam kasus ini, kami melaporkan seorang pasien laki-laki berusia 24 tahun dengan achalasia esofagus. Tantangan teknis dalam kasus ini adalah adanya lobus hati kiri yang besar dan menonjol. Pasien laki-laki berusia 24 tahun tersebut dirawat di Rumah Sakit Umum Prof. IGNG Ngoerah dengan keluhan utama disfagia. Pasien mengeluhkan kesulitan menelan selama tiga bulan terakhir. Awalnya pasien merasakan ada yang tersangkut setiap kali makan dan minum. Keluhan tersebut memburuk dalam sebulan terakhir hingga pasien tidak dapat menelan makanan padat sama sekali. Pada saat masuk rumah sakit, pasien masih bisa mengonsumsi makanan cair. Tidak ada kelainan yang ditemukan pada pemeriksaan fisik dan hasil laboratorium. Evaluasi oesophagogram menunjukkan hampir total stenosis pada esofagus distal yang mencapai setinggi CV Th12 yang menyebabkan dilatasi pada esofagus proksimal. Hasil tersebut juga menunjukkan adanya dilatasi pada esofagus. Kemudian, pasien menjalani prosedur laparoskopi Heller Myotomy, namun karena adanya lobus hati kiri yang besar dan menonjol, prosedur tersebut diubah menjadi laparotomi dengan Dor fundoplikasi. Pasien mengalami pemulihan tanpa komplikasi selama tindak lanjut. Achalasia esofagus berhasil diatasi dengan Heller Myotomy. Lobus hati kiri yang besar dan menonjol dapat menjadi tantangan dalam prosedur ini.References
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