EMERGENCY CASE REPORTS

Saturday, January 12th 2018

SURGERY DEPARTMENT

EMERGENCY ROOM
Wahidin Sudirohusodo General Hospital
Makassar
EMERGENCY CASE REPORT
Monday, January 12th 2018
Ambulation : 1 Patient
Hospitalized : 7 Patients
Observation : - Patient
Operated : 1 Patient
Death : - Patient
Total : 8 Patients

Wahidin Sudirohusodo General Hospital

Makassar
 Name : N Age : 25 years old
RM : DPJP :

Chief complain : whole abdominal pain

History taking : This condition had been suffered for 2 days before
admission, and worsened 3 hours before came to hospital.
Previous;y, this patient had been operated of laparoscopic
appendectomy due to acute appendicitis on Faisal Hosptal,
7 days ago. For 2 days, the pain was decreased then back
home. But 3 hours before admitted, the pain aggravated
incidentally in whole abdomen. This patient got fever, and
vomited 3 times in a day.

Micturition Normal

Defecation Normal
 PHYSICAL EXAMINATION
• GENERAL STATUS
Karnofsky 70%/ well nourished/conscious
• VITAL SIGN
– BP: 110/80 mmHg
– HR : 100 x/minutes, regular, adequate.
– RR: 20 x/mnt, spontaneous, symmetric adequate chest movement,
thoracoabdominal type.
– T (ax) : 37,6°C,
 Local Status
Abdomen :
• I : flat , bowel counter (-), bowel motion (-), surgery
marks seen post laparoscopic
• A : Peristaltic (+), metallic sound (-)
• P : Tenderness (+) whole abdomen, defans muscular (+)

• P : Tympani (+), tapping pain (+), liver dullness(+)

Digital Rectal Examination

Sphincter tone was loose

Rectal mucosa smooth
Ampulla recti no collaps
No palpable mass
Handschoen: blood (-), feces (+), slime (-)
 Clinical Diagnosis
• Generalized Peritonitis ec susp. Hollow
viscus perforation post laparascopic
appendectomy
 Laboratory findings :
Hb : 13.6 g/dl Cr : 0,71mg/dl
Hct : 40% GDS : 126 mg/dl
WBC : 20.000 / uL Na : 136
PLT : 309.000 / uL K : 4.1
APTT : 29.5 Cl : 102
PT : 12
SGOT : 27
SGPT : 23
Albumin : 4.0
Ur : 18mg/dl
 Working Diagnosis
• Generalized Peritonitis ec susp. Hollow viscus perforation
post laparascopic appendectomy
 Management
• IVFD
• Medicaments
• Plan : Immediate Exploratory Laparotomy
 Operation report
• The patient lied in supine position under general anesthesia combined with epidural aneshesia
• Disinfection and drapping procedure were performed on abdominal surface
• Incision was performed from 1 finger above umbilicus to 2 fingers above symphisis pubis, the
incision was deepened sharply until peritoneum was visualized.
• Opened peritoneum, approximately 100 cc of yellowish-pus flew out and was collected for
microbiology culture
• Hollow viscus was identified, post appendectomy punctum was found necrotize and perforative.
• Primary hecting was perfomed and continued with tabassar procedure and omental flap
• Bleeding was controlled and surgery wound was being cleansed.
• Surgery wound was closed layer by layer with 2 drain tubes was left inside.
• Surgery wound was closed
• Operation finished
POST OP DIAGNOSIS : Generalized Peritonitis ec Necrotic Stump at punctum
appendix Post Laparoscopic Appendectomy

PROGNOSIS : Prognosis : Good

FOLLOW UP : Vital sign

Drain production
Wound healing
Thank You