Appendicitis :

“ When the Bread makes you

Breathless “
Hendro Wartatmo
Dept. of Surgery
“ There is no Simple Surgery
but Simple Fee “
 Case # 1
 Girl, 11 ys, with chief complain of abdominal pain. Surgery
was taken out based on diagnosis of acute appendicitis.
Operative finding was an appendix with minimal
inflamation.
 On the day 11th laparatomy was performed due to
intraabdominal abscess. There were two pockets abscess
contains 2000 cc pus found, and two resctions and
anastomoses need to accomplished these surgery.
 Patient is survive, but the father charged the hospital and
all the the doctors who participate in the patient
management of the first surgery.
 ….
 Case # 2

 Gadis 18 th, tinggal di luar Jawa, dg klinis app

kronis. Ybs minta operasi ditunda satu bulan lagi
setelah menjalani test PMB. Dokter bedah
mengatakan operasi sampai penyembuhan hanya
perlu waktu +/- 2 minggu.
 Operasi jadi dilaksanaka. Pasca bedah terjadi
infeksi luka operasi yang perlu waktu lebih dari 1
bulan untuk sembuh. Pasien gagal ikut test PMB.
Kasus 3  Mahasiswa sem 3 di
operasi dg diagnosis app
akut. Durante op
dijumpai apendik yang
meradang berat,
dilakukan apendektomi.
 Hari ke 6 p.o timbula
gejala ileus, dilakukan
relap, dijumpai volvulus
usus halus. Dilakukan
reseksi anastomosis.
 Komlikasi : shot bowel
syndrome. Diperlukan 1
kali operasi lagi dan total
masa perawatan 4 bl
sampai pasien kembali
normal.
 Acute Abdominal Condition :

“ It’s better to look and see rather than wait and

see “

“ When in doubt, open it ! “

“ Happy is he who has no serious consequences of

his erroneous diagnosis to regret “ ( Marsh )
 Peritonitis
 Inflamation of the peritoneum.
 A condition marked by exudation in the
peritoneum of serum, fibtin, cells and pus.
 It is attended by abdominal pain and
tendernes, constipation, vomiting and
moderate fever.

( Dorland Medical Dictionary )

 Acute Appendicitis
 Acute :
• Catharralis
• Suppurative
• Gangrenous
• Perforate

 Complicated
• Acute appendicitis with periapendiculair mass
• Acute appendicitis with periapendiculair abscess
Diagnosis

 Klinis
 Laboratoris
 Penunjang
Terapi

 Operatif
Apendikogram
Apendisitis akut
suppurativa
Acute apendicytis with
periapendiculer mass
 Abdomen 3 posisi
( Peritonitis - Perforasi )
 Ileus :
 Obstruction of the bowel producing severe
colic.

( Dorland Medical Dictionary )

 Gangguan passage usus dari oral ke anal.

 Diagnosis

 Anamnesis :
• Tidak bisa BAB – flatus, mual, muntah, kembung
 PD :
• Dehidrasi
• Darm steifung, darm contour, metalic sound, borborigmi
 Penunjang :
• Lab : Hemokonsentrasi, uremia, leukositosis
• Oligouria, BJ naik
• Foto Ro

 Tanda-tanda dehidrasi & Sepsis

 Terapi :

 Rehidrasi
 Antibiotika

 Operatif
Abdomen 3 posisi
( Ileus obstruktif )
Volvulus
Ileus obstruktif