M/M/42 yo

82.37.61
Chief Complain: unable to pass stool

It had been suffered since 10 days before admitted to

Adam Malik hospital, followed by unable to pass gas
since 3 days ago. History of abdominal enlargement
was found since 10 days before admission, change of
bowel habit such as intermittent diarrhea was found for
the last 1 year, bloody stool was found, goat-stool like
feces was found. Body weight loss (+) 15 kg in 2
months. History of nausea and vomiting was found.
Patient also complained of intermittent micturition
since 2 months ago.
 Present State
• Awareness : Alert
• BP : 100/70 mmHg
• HR : 98 beats/minute
• RR : 20 times/minute
• Temp : 36,8 0 C
• BW : 65 kg
• VAS :5
 Generalized State

• Head : no abnormality was found

• Neck : no abnormality was found
• Chest : no abnormality was found
• Abdomen : In localized state
• Genitalia : Male, no abnormality was found
• Extremities : no abnormality was found
 Localized State
Abdomen :
I: Symmetrical, distension (+), visible bowel
contour (-), visible bowel movement (-)
P : muscular rigidity (-), tenderness (-)
P : hypertympani, liver dullness (+)
A : peristaltic (+) increased, Borborygmi (+)
metallic sound (+)

DRE :
Perineum normal, Anal sphincter tone was
tight, ampula was collapsed, mass was not
found, pain was not found
Gloves: feces (-), blood (-) and mucous (-)
 Laboratory Findings
• Hb/Hct/WBC/PLT : 11/34/8690/315.000
• Na/K/Cl : 134/3.1/98
• Ureum/Creatinin : 17/ 0.64
• Glucose ad Random : 98
Chest X-Ray
Abdominal X-Ray
CT SCAN WHOLE ABDOMEN
CT SCAN WHOLE ABDOMEN
CT SCAN WHOLE ABDOMEN
CT SCAN WHOLE ABDOMEN
 Working Diagnose
Total Mechanical Bowel Obstruction d/t Rectum
Tumor 3cm ACL Sugg Malignant
cT4aN0M1(Lung)
 Management at Emergency Room
• Nil per mouth
• IVFD crystalloid  IVFD Ringer lactate 20 dpm
• NGT  came out greenish liquid about 100 cc
• Urine cateter  came out 150 cc clear yellow urine
 UOP : 60 cc/hour
• Antibiotic Inj.  Ceftriaxone Inj. 1 gr IV
• Analgetic Inj.  Ketorolac Inj. 30 mg IV

Plan : Diverting colostomy + Rectal biopsy

 In Operating Theatre
• Patient in supine position
under general anasthesia
ETT, aseptic, antiseptic
procedure.
• Contra McBurney incision,
cutis, subcutis, fascia, muscle
was cut, peritoneum was
opened.
• Identification of sigmoid,
sigmoid was preserved with
nelaton catheter. Proximal
stump was on the lateral
position and distal stump on
the medial position.
• Sigmoid was fixated to
fascia with 8 directions.
• Sigmoid was cut.
• Performing rectal biopsy,
pasien was lithotomy
position, the specimen was
sent to Pathology Anatomy
Department for
histopathologic
examination.
• Operation was done