S/M/71yo

84.66.35
Chief complaint : Unable to defecate
It has been suffered in 3 days before admission. History of
having lump was found at his right inguinal for 1 years, the
lump occured oftenly when patient doing an excessive job or
straining, and the lump dissapeared when the patient resting.
The lump has persisted for 7 days. Pain (+) inttermitenly.
Nausea and vomitus (-), flatus (-). Micturation (+). History of
chronic cough (+). History of fever (+) in this 3 days.
History of smoking (-)
History of past illness : DM (-), HT (-)
History of previous surgery (-)
Present State :
• Awareness : Alert
• BP : 140/90 mmHg
• HR : 90 beats/minute
• RR : 18 times/minute
• Temp : 36.50 C
• VAS Score : 3
Generalized State
• Head : No abnormalities was found
• Neck : No abnormalities was found
• Chest : No abnormalities was found
• Abdomen : In localized state
• Genital : Male, In localized state
• Extremity : No abnormalities was found
Localized state:
• Abdomen:
I : symmetrical, distention (-), visible bowel movement (-)
A: peristatic (+) increase, metallic sound (-)
P: liver dullness (+), tympani
P: smooth, muscular rigidity (-)

• DRE :
Perineum was normal, Anal Sphincter Tone was tight,
smooth mucosal layer, ampula recti was collapsed,
mass(-), pain (-)
Gloves : blood (-), feces (+),mucous (-).
• Genitalia:
Male, mass (+) on L) scrotum, soft consistency,
smooth surface, well circumscribed, color similar
to the surrounding skin, transillumination (-),
pain (-), peristaltic (+), size 10x8x5 cm.
Clinical
Chest x-ray
Laboratory Finding
• Hb/Ht/Wbc/Plt : 16.5/49/16.170/213.000
• Na/K/Cl : 135/4.2/105
• Rapid Test anti Covid-19 : Non reaktif
Working Diagnosis : (L) Incarcerated Lateral
Inguinal Hernia + Susp. Covid-19
Management at Emergency Department :
• Fasting
• IVFD Crystalloid
• Inj.Antibiotic
• Inj.Analgetic
• Installation of NGT, came out clear liquid about 50 cc
• Installation of Catheter, came out initial urine output
about 100 cc with clear yellow colour
• Plan for (L) Hernioraphy emergency
 Operation Theatre
• Patient in supine position under Spinal
Anesthesia, aseptic and antiseptic
procedure was done.
• Incision (L) inguinal oblique: cutis,
subcutis, external oblique aponeurosis
were divided
• Both flaps were mobilized
• Lifting sprematic cord from inguinal
canal at pubic tubercle and then
dissecting bluntly until the cord
completely free
• Sac was seen and opened.
Sac content was small bowel
and caecum approximately
20 cm illeocaecal junction to
caecum.
• Internal ring was release,
then identification of wedge
area. Compressed with
warm saline, and tactile
stimulated, color
reddish,peristaltic (+), seems
viable.
• Sac content returned
to abdominal cavity.
• Proximal and distal
sac were separated
and the proximal one
was ligated at the
preperitoneal fat.
• A 15x7 cm prolene mesh
was applied and fixated
to tuberculum pubicum,
conjoint tendon,
inguinal ligament.
• Bleeding was controlled,
surgical wound was
closed layer by layer.
• Operation was done.