EMERGENCY CASE REPORT

Wednesday, June 7th 2023

SURGERY DEPARTEMENT

EMERGENCY ROOM
Wahidin Sudirohusodo General Hospital
Makassar
EMERGENCY CASE REPORT
Wednesday, June 7th 2023
Outpatient : 1 Patient
Observation
: 0 Patient

Inpatient : 9 Patients
Operation : 1 Patient
Mortality : - Patient
Total : 11 Patients

Wahidin Sudirohusodo General Hospital

Makassar
 New Patient Data
ER WAHIDIN SUDIROHUSODO HOSPITAL
Wednesday, June 7th 2023
No
. Name Umur JK No. RM DPJP Diagnosis
Tn. Dennye
1 79 L 1024903 dr. KK Hematuria + Hipertropi Prostat Grade III + Post TURP + anemia
Panggalo
2 Tn. Syafruddin 30 L 927726 dr. AZ Left Flank pain et causa nefrolithiasis sinistra
Sarcoma Regio Genu Dextra CT3N0M0, karnofsky 80% + cancer
3 Tn. Joni Sale 54 L 1016525 dr. DJF
pain

4 Multple Limfadenopati regio coli suspect Limfoma Maligna grade

Tn. Iwan 29 L 1021368 dr. WH II ann harbour classification + severe trombositopenia
Rectosigmoid tumor CT4N0M1 hepar + fistula rectovagina +
5 dr. SM
Ny. Sitti Mariam 35 P 1025148 Anemia (rhesus negative)
Abdominal tumor Susp Mesenteric Desmoid Tumor + abdominal
6 Ny. Swarni Daud 71 P 521912 dr. WS
colic pain
Ny. Martha
7 74 P 373975 dr. AZ Left flank pain et causa Nefrolithiasis sinistra
Kombong
post laparatomy procedure et causa perforasi divertikel colon +
8
Tn. Sufraedi  48 L 102934 Dr. IK  abdominal colic pain
Rhabdomyosarcoma Gluteus Dextra cT2bN1M1 (tulang),
9 Ny. Kuanti 49 P 983060 Dr. DJF
stadium IV, karnofsky 40%
An. Alexander Generelise peritonitis et causa Appendix Perforation + total ileus
110
Davinov 18 L 1025169 Dr. IK obstruction
 Name : Mr. AD MR : 1025169
Age : 18 y.o DPJP : Dr. IK

Chief complain : Whole Abdominal Pain

History taking : Whole Abdominal pain has been felt since 3 days ago. Initially, the patient
complained of pain in the right lower abdomen that radiated posteriorly of the
abdomen since 7 days ago. Pain is felt continuously. Pain increases when the
patient changes position and is reduced by administering anti-pain injections.
The patient also complained of abdominal distend that had been felt for the
past 3 days, accompanied by nausea, and vomiting containing a greenish-
yellow liquid. No defecation since 3 days ago, no flatus since last 1 day.
There is no history of dark feces,
There is no history of bloody feces
There is a history of fever since 7 days ago
There is no history of previous operations
There is no history of trauma
The patient was referred from Polewali Hospital and had a urinary catheter and
nasogastric tube with a production of 1000 cc of greenish-yellow color
 Physical Examination

General Examination
Moderate Illness/ GCS 15

Vital Sign
BP : 90/53 mmHg
HR : 92 x/mnt, reguler
RR : 18 x/mnt
Temp : 36,7°C
 Physical Examination
Secondary Survey
Abdomen

Inspection : Distended (+), follows breathing movements, darm steifung (-), darm
contour (+)
Auscultation : bowel sounds (+) increase, metalic sound (+)
Palpation : Tenderness (+) at the entire regio of abdomen
Percussion : Hypertimphani
 Digital Rectal Examination
Loose Spinchter, the mucosa is smooth, the ampulla is collapsed, no
mass is palpable, no tenderness

Handscoon: feces (+), slime (-), blood (-)

 Clinical Diagnosis
1. General Peritonitis et causa susp. Appendix Perforation
2. Total Ileus Obstruction
 Laboratory Finding
 HB : 13,3
 WBC : 17,4
 PLT : 385.000
 GDS : 79
 Na : 132
K : 3,3
 Cl : 108
X-Ray Thorax
MSCT Abdomen
DIAGNOSA KERJA : • Generalize Peritonitis ec Susp
Appendix Perforation
• Total Ileus Obstructive
Treatment : • Resusitation RL 1000 cc
• IVFD Nacl 0.9 % 28 dpm
• Ceftriaxon 1gr/12h /iv
• Metronidazole 500 mg/12 h/iv
• Ranitidin 50mg/ 12 h/iv
• metamizole 1gr/8jam/iv

PLAN : • Cito Laparatomy Exploration

Operation Findings
 Operation Report
1. The patient lies supine under general anesthesia
2. Disinfection and draping procedures in the abdominal region
3. Midline incision 3 fingers below the xiphoid process to 2 fingers above the
symphysis pubis Deepen layer by layer sharply and bluntly until it reaches the
peritoneum, opening the peritoneum
4. There was an abdominal discharge of about 300 ml of serohemorrhagic color and
then identification of the intra-abdominal organs was carried out Visible dilatation
of the small intestine from the stomach, duodenum to 100 cm from the ileocaecal
junction, ileum, and caecum bands were found at around 100 cm from the ileocaecal
valve, followed by band release
5. Identification of perforated appendicitis with an edematous appendix, hyperemia
accompanied by multiple micro perforations distally, and lots of fibrin tissue, then it
was decided to perform an appendectomy with double ligation
6. Wash the abdominal cavity with normal saline until clean
7. Control bleeding and install 1 drain in Cavum Retzii
8. Suture the surgical wound layer by layer
9. Operation complete
Post Op Diagnostic : • General Peritonitis et causa
Appendisitis Perforasi
• Total Ileus Obstructive et causa Band
Ileocaecal
FOLLOW UP : • Vital Sign
• Acute Abdominal Sign
• Measure drain, NGT and Catheter
Production
PROGNOSIS :
Ad vitam • Dubia
Ad functionam • Dubia
Ad sanationam • Dubia
THANK YOU
 Name : Mr. H MR : 1025164
Age : 47 y.o DPJP : Dr. WS

Chief complain : Abdominal Bloating

History taking : Abdominal bloating that has been felt since 7 days ago. This complaint
has been getting worse since the last 2 days. Feel pain in the right
abdomen. Pain is felt intermittently. complaints of vomit containing
yellow-green liquid. No defecation in the last 6 days. Flatus absent for
the last 1 day.
There is a history of watery feces mixed with fresh blood.
There is no history of defecation like goat manure.
There is a history of fever for the last 2 days
There is a history of weight loss, 8 kg in the last 6 months
The family history of tumor disease was denied
Surgical history denied
The patient was referred from the Pinrang hospital, and a urinary
catheter and a nasogastric tube were placed with a greenish-yellow
fluid production of around 2000 cc.
 Physical Examination

General Examination
Moderate Illness/ GCS 15

Vital Sign
BP : 140/80 mmHg
HR : 80 x/mnt, reguler
RR : 20 x/mnt
Temp : 36,7°C
 Physical Examination
Secondary Survey
Abdomen

Inspection : looks convex, follows breathing movements, darm steifung (-), darm
contour (-)
Auscultation bowel sounds (+) increased
Palpation : Distended (+) Tenderness (+) at the entire Abdomen Region, No.
mass palpable
Percussion Hypertimpani
 Digital Rectal Examination
The anal sphincter is loose, the mucosa is smooth, the ampulla is
collapsed, no mass is palpable, no tenderness

Handscoon: stool (+) dark brown, slime (-), blood (-)

 Clinical Diagnosis

Obstructive Ileus ec Suspect Tumor Sigmoid Colon

 Laboratory Finding
 HB : 11,9
 WBC : 43100
 PLT : 456000
 GDS : 122
 Na : 131
K : 3,9
 Cl : 97
 Albumin : 2,8
XRAY THORAX
BNO
DIAGNOSA KERJA : • Ileus Obstruktive ec Susp Sigmoid
Tumor

Treatment : • IVFD NaCl 0,9% 28 dpm

• Ceftriaxone 1 gram/12 h/intravena
• Metamizole 1 gram / 8 h/ intravena
• Ranitidine 50 mg / 12 h/ intravena

PLAN : • Cito Laparatomy Explorasi

Operation Findings
Operation Report
Post Op Diagnostic :

FOLLOW UP :

PROGNOSIS :
 Name : Mrs.D No. Reg : 1024914
Age : 55 y.o DPJP : Dr. NAL

Chief complain : Decreased consciousness

History taking : The patient consulted from neurologist with decreased consciousness
experienced since 11 days ago, the patient suddenly fainted and then
became unconscious. There is no history of vomiting, no history of
seizures, no history of trauma.
There is a history of hypertension since 5 years without routine
treatment. There is History of uncontrolled DM .
Patient was Referred from Morowali Hospital on the 11th days of
treatment with a history of admission to Hospital with GCS 6 E2M3V1
:
 Physical Examination

General Examination
Moderate Illness/ GCS 10 E3M5V2

Vital Sign
BP : 237/109 mmHg
HR : 114 x/mnt, reguler
RR : 20 x/mnt
Temp : 36,5°C
 Physical Examination
Secondary Survey
Head

Inspection : Normocephal, Hematome (-)

Palpation : Tenderness (-)
 Neurological Examination
GCS 10 E3M5V2
Pupil isochor 2,5mm/2.5 mm
DLR +/+ IDLR +/+
N. Cranialis Difficult to Assess
Motorik: No Lateralitation
Sensorik: Difficult to Assess
Otonom: No Defecation, Normal Urine with
Urine Catheter
 Clinical Diagnosis
Decreassed Conciousness Supect Intracranial Hemmorage

Hipertensi Grade II

Diabetes Mellitus Type 2

 Laboratory Finding
 HB : 15,7
 WBC : 11500
 PLT : 444000
 GDS : 136
 Na : 142
K : 3,4
 Cl : 103
XRAY THORAX
HEAD CT SCAN
DIAGNOSA KERJA : • Spontaneus Intraventricular
Hemorrhage
• Hipertensi Grade II
• Diabetes Melitus Type 2
Treatment : • IVFD Nacl 0,9% 20 tpm
• Nicardipin 0,3 mcg/kg/min, (BB 75
KG). -> 6.75cc/h/SP
• Citicolin 500mg/12 h/intravena
• Omeprazol 40 mg/24 h/intravena
• Mecobalamin 500 mog/24
h/intravena
• Nimotop 60 mg/4 h/NGT (4-1)
• Ketorolac 30 mg/12 h/intravena
• Glaucon 250 mg/12 h/NGT
• Atorvastatin 20 mg/24 h/NGT
PLAN : • External ventrikuler drainage cito
Operation Findings
 Operation Report
1. The patient lies supine under general anesthesia
2. Disinfection and drapping procedures on the right parietal region
Semilunar incision at Kocher's point Dextra, deep into the cranium
3. One burrhole was performed, then the arachnoid layer was coagulated
using a bipolar electrocautery
4. Insert a ventricular drain with a trajectory leading to the ipsilateral
medial canthus to a depth of 5 cm, cerebrospinal liquor looks
serohemorrhagic with an opening pressure of 15 cmH2O
5. Tunneling and EVD drain fixation was performed using silk 2.0
6. Bleeding control using bipolar electrocautery and surgicel, then
suturing the surgical wound layer by layer
7. Operation complete
Post Op Diagnostic : • Spontaneus Intraventricular
Hemorrhage
• Hipertensi Grade II
• Diabetes Melitus Type 2
FOLLOW UP : • Vital Sign and GCS
• Measure the production of EVD
• Wound Care

PROGNOSIS : • Dubia et bonam

 Name : Boy. A MR : 1025167
Age : 14 y.o DPJP : Dr. UM

Chief complain : Abdominal Pain

History taking : The patient came with complaints of lower right abdominal pain since 1 month before
came to the hospital. Complaints accompanied by a lump in the stomach along with pain,
initially the size of a ping pong ball then enlarged rapidly to the entire right upper
quadrant within 6 days.
There is nausea, no vomiting. No fever. No tightness. Urinary and Defecation are normal
impression.
There is no history of weight loss, There is no history of previous trauma at the location of
the lump, There is No. history of bloody feces, History of feces such as goat manure does
not exist.
There is no history of change of bowel habits
The patient was referred from the Takalar hospital with abdominal colic ec intra-
abdominal tumor, was given fluid therapy & anti-pain injections
Pregnancy history: The patient is the 3rd child of 5 siblings. History of regular control at
the doctor, routinely taking vitamins, no history of using drugs during pregnancy, not
taking herbal medicine during pregnancy
Birth history: Full term pregnancy, spontaneous birth with the help of a midwife. A normal
weight (the family forgets how many), immediately cries. There is no family history of the
same disease. There is no family history of congenital abnormalities
 Physical Examination

General Examination
Moderate Illness/ GCS 15

Vital Sign
BP : 110/70 mmHg
HR : 92 x/mnt, reguler
RR : 18 x/mnt
Temp : 36,7°C
Secondary Survey
Physical Examination
Abdomen

Inspection : looks flat, follow the movement of breath. Darm Countour doesn't exist, Darm Steifung
doesn't exist
Auscultation bowel sounds (+) normal
Palpation : palpable mass in the right quadrant of the abdomen, the size of about 7 cm x 5 cm x 7 cm in
diameter. Boundary not clear, surface flat, not lumpy, hard solid consistency, fixed. The color of
the lump is the same as the surrounding skin. Tenderness (+)

Percussion Tympani
 Digital Rectal Examination
The anal sphincter is good, the mucosa is smooth, the ampulla is not
collapsed, no mass is palpable, no tenderness

Handscoon: feces (+), slime (-), blood (-)

 Clinical Diagnosis
Partial Ileus Obstruction ec Intraabdominal Tumor
 Laboratory Finding
 HB : 9,5
 WBC : 7,5
 PLT : 515000
 GDS : 120
 Ur : 13,5
 Cr : 0,26
 SGOT : 21
 SGPT : 13
XRAY THORAX
USG
MSCT Abdomen
DIAGNOSA KERJA : • Colic Abdomen ec Tumor
Intraabdomen susp Malignancy

Treatment : • Asering 16 dpm

• Omeprazole 40mg/ 24 h/iv
• metamizole 1gr/6h/iv drip

PLAN : • Laparatomi Biopsi Tumor

Thank you