DEPARTMENT OF OBSTETRICS AND GYNAECOLOGY

FACULTY OF MEDICINE SRIWIJAYA UNIVERSITY

Dr. MOH. HOESIN GENERAL HOSPITAL PALEMBANG

LAPORAN OPERASI ONKOLOGI

28 Agustus – 3 September 2019

Residen Stase Onkologi

Dr. Uci Elisa

Supervisor:

Dr. H. Patiyus Agustiansyah, SpOG (K), MARS

 DEPARTMENT OF OBSTETRICS AND GYNAECOLOGY

FACULTY OF MEDICINE SRIWIJAYA UNIVERSITY

Dr. MOH. HOESIN GENERAL HOSPITAL PALEMBANG

RECAPITULATION PATIENT OPERATING THEATRE REPORT

Oncology Operative COT I

Date Dr. Irawan Dr. Patiyus

Dr. Rizal Sanif,
Sastradinata SpOG Agustiansyah SpOG
SpOG (K) MARS
(K) MARS (K) MARS
Wednesday,
- - -
August 28th, 2019
Thursday, August
1 - -
29th, 2019
Friday, August
- - -
30th, 2019
Monday, Sept
- 1 1
02nd, 2019
Tuesday, Sept 03rd
- 1 -
, 2019

TOTAL 1 2 1
 DEPARTMENT OF OBSTETRICS AND GYNAECOLOGY

FACULTY OF MEDICINE SRIWIJAYA UNIVERSITY

Dr. MOH. HOESIN GENERAL HOSPITAL PALEMBANG

RECAPITULATION BASED ON OPERATING THEATRE REPORT

Diagnosis ICD 10 Procedure ICD Number of
9 Cases
O14.9 LSCS 74.1 1
O30.0
Cyst Ovarian Neoplasm with C 56.9 Surgical Staging (TAHBSO 54.1 1
solid part , malignancy was + Lifadenectomy bilateral + 183.0
suspected Partial Omentectomy) + Stab
Wound drain
Cyst Ovarian Neoplasm C 56.9 Conservative Surgical 54.1 1
,malignancy was suspected Staging (USO + Partial
Omentectomy)

TOTAL 3
 DEPARTMENT OF OBSTETRICS AND GYNAECOLOGY

FACULTY OF MEDICINE SRIWIJAYA UNIVERSITY

Dr. MOH. HOESIN GENERAL HOSPITAL PALEMBANG

No Date Identification Diagnosis ICD 10 Management / ICD

Procedure 9
1 29.8.19 Mrs. MIS Preo Diagnosis C56.9 - Ascites 54.9
41/RA/P2A0 : R18.8 evacuation 48.2
RS - DRI Ovarian cancer J91.8 - Peritoneal
stage IIIC biopsy
complete
therapy +
ascites +
bilateral pleural
effusion

Postop
Diagnosis
Recurrent
ovarian cancer
2 02/09/19 Mrs. ALO / 42 yo / Preoperative C 56.9 Surgical Staging 54.1
UA / 908468 / IS Diagnosis : (TAHBSO + 183.0
Cyst Ovarian Lifadenectomy
Neoplasm with bilateral +
solid part , Partial
malignancy was Omentectomy)
suspected + Stab Wound
drain
Recent
Diagnosis :
Ovarian Cancer
Clinical Stg IC
+ Stab wound
drain
3 02/09/19 Ms. RIE / 12 yo / Preoperative C 56.9 Conservative 54.1
RA / 1129837 / AT Diagnosis : Surgical Staging
Cyst Ovarian (USO + Partial
Neoplasm Omentectomy)
,malignancy
was suspected
 Recent
Diagnosis :
Ovarian Cancer
Clinical Stg IA
4 03.09.19 Mrs. WAT/ 58 yo/ Preoperative I 83 Laparotomy
P3A0/ RA/ IS Diagnosis : Seconday
Ovarian cancer debulking
advance stage
post NAC 3
course

Date of visit/ hospitalized 20-08-2019

Identity

Name Misinem bt Radun

Med Rec/ Reg 1101396

Age 11-10-1977/ 41 yo

Address Tugu Mulyo, MURA

Operator Dr. H. P. Agustiansyah, SpOG(K)

Resident Dr. Idries Tirta Husada

Anamnesis

Chief complaint Abdominal enlarged and pain

History ± 1 week admission patients complained Abdominal

enlarged and pain.

H/vaginal bleeding (-), H/post coital bleeding (-

),H/leuchorrea (-), H/ dyspareunia (-), H/ dyschezia
(-), H/ decreased appetite (-), H/weight lost (-),
Defecate and urinate in normal limit.

Since January 2019 patient had D/ Ovarian cancer

stage IIIC and got chemotherapy.

Past operation & Past Illness Surgical staging at Moh. Hoesin hospital 16-01-2019
with PA result 197/A/2019”

High grade serous carcinoma at ovarian DD/ High

grade endometrioid carcinoma, high grade serous
carcinoma at bilateral ovarian that metastase until
subserous myometrial. Limfangio invasion (+).
There was no tumor mass at fallpopian tube.
Metastase high grade serous carcinoma at omentum.

Chemotherapy Docetaxel-Carboplatin 6 course

(finished)  last 10-05-2019

Marrital 1x, for 17 years

Obstetric P2A0

Menstrual Post TAH BSO (Surgical staging)

Economic and nutrition status Moderate

Physical examination

General condition Good RR 20x/m

Sens CM Pulse 80x/m

BP 110/70 mmHg Temp 36,20C

Weight 53 kg Height 145 cm

Gynecology status PL : Convex abdominal, symmetrical, mass (-),

abdominal tenderness (-), free fluid sign (+)
(DRI) massive

Inspeculo: vaginal vault in normal limit.

VT: vaginal vault in normal limit.

RT: Sphincter ani was good, smooth mucous,

intraluminal mass (-), ampula recty was empty.

USG (NS) 19-08-2019 Both of ovarian non visual ~ post TAH-BSO

Liver and both of kidney in normal limit

There was massive ascites.

There wasn’t growth new mass

K/ There wasn’t growth new mass

There was massive ascites

Suggestion: CT Scan

Abdominal CT Scan 23-08-2019 Massive ascites + Bilateral pleural effusion

PA result of ascites fluid cytology Metastasic carcinoma at ascites fluid

1501/C/2019 23-08-2019

Laboratory examnination 20-08-2019 Hb 11.1 g/dL, WBC 7.650/mm3, PLT 321.000/µL,

SGOT 13 U/L, SGPT 7 U/L, BSS 114 mg/dL, Cr
0.74 mg/dL, Ur 17 mg/dL

24-08-2019 Albumin 3.2 g/dL,

Diagnosis Ovarian cancer stage IIIC complete therapy +
Massive ascites + Bilateral pleural effusion

Post op:

Recurrent Ovarian cancer + Massive ascites + Stab

wound drain

Planning Secondary debulking

Intrapoerative Finding

13.00 PM: Operation started.

Patient on supine position and undergeneral anesthesia.

Aseptic and antiseptic were done on operating area.

Operation site narrowed with sterile cloth. Then continue with mediana incision above prevous
scar.On exploration was found :

Ascites ±4500 cc  PA

On exploration found seeding tumor on gut, liver, abdominal wall, peritoneum  biopsy
peritoneum PA

Perform stab wound drain

14.00 PM: Operation started.

Date of visit/ hospitalized 25-04-2019

Identity

Name Aloh bt Lacok

Med Rec/ Reg 908468

Age 42 yo

Address Sukarami, PLG

Operator Dr. H. Irawan Sastradinata, SpOG(K), MARS, SH

Resident -

Anamnese CC: Abdominal enlargement and pain.

Since 2 months before admission patient complained abdominal

enlargement, pain (+).

H/ vaginal bleeding (-), h/ post coital bleeding (-), h/ leuchorrea (-),

h/ dyspaerunia, h/ dyschezia, h/ decreased of appetite (-), h/ weight
lost (-), h/ defecate and urinate in normal limit.

Physical Examination Menstrual: Menarche 13 yo, irregular menstraul cycles, for 5-7 days,
LMP 20-08-2019

Marrital : Married 2x: 1) 20 years, 2) 8 years

Obstetric: P7A0

Prior operation & Past illness : -

Physical examination : BP : 120/70 mmHg, HR: 88x/m, RR: 20x/m,

T: 36.3ºC, Weight 61 kg, height 152 cm.

General status : Normal

Gynecologic status :

Inspection: Convex abdominal, symmetrical, uterine fundal height

difficult to assessed, massa (+), cystic, immobile, upper border was 2
fingers below proc. xyphoideus, right border was right LAA, left
border was left LAA, below border was symphysis, abdominal
tenderness (+), free fluid sign (-)

Inspeculo: portio didn’t livide, OUE closed and attracted to the top,
fluor (-), fluxus (-), E/L/P (-).

VT: portio firmed, OUE closed and attracted to the top, CUT difficult
to assessed, CD was protrude, both of AP were tense, palpable cystic
mass, immobile, sized 20x15 cm
 RT: Sphincter ani was good, smooth mucous, intraluminal mass (-),
ampula recty was empty, palpable mass at anterior of rectal mucous
sized 10x10 cm, CUT difficult to assessed, both of AP were tense,
palpable cystic mass, immobile, sized 20x15 cm

USG (PB) 26-04-2019 Uterine was AF, shaped and sized in normal limit.

Myometrium was homogen, basal statum was regular, endometrial

line 3 mm.

Portio and endocervical in normal limit.

There was cysti mass with septa (septa thick 6 mm) with solid part,
sized 20x14.6 cm, fill the entire abdominopelvic cavity possibility
cyst ovarian neoplasm with solid part malignancy was suspected.

Contralateral ovarian difficult to assessed.

There weren’t enlarged paraaorta and bilateral parailiaca lymph

nodes.

Liver and both of kidney in normal limit.

Ascites (-)

Internal genitalia adhesion

C/ Cyst ovarian neoplasm with solid part malignancy was suspected.

Internal genitalia adhesion

Laboratory examination Hb 11.0 g/dL, WBC 8.550/mm3, PLT 531.000/µL, SGOT 14 U/L,
29-04-2019 SGPT 10 U/L, Albumin 4.0 g/dL, Cr 0.81 mg/dL, Ur 24 mg/dL, AFP
1.81 ng/mL, CEA 1.10 ng/mL, CA 125 191.2U/mL

RMI 3 = U x M x CA 125 = 3x1x191.2= 573.6 (malignancy)

RMI 4 = U x M x S x CA125 = 4x1x2x191.2 = 1,528 (malignancy)

Diagnosis and Planning Diagnosis:

Cystic ovarian neoplasm with solid part malignancy was suspected

Planning:

Laparotomy Surgical Staging

Intraoperative Findings
15.00 PM: Operation started.

Patient on supine position and under spinal anesthesia.

Aseptic and antiseptic were done on operating area.

Operation site narrowed with sterile cloth. Then continue with mediana incision . On exploration
was found :

Multiloculare cyst mass with size 30x30 cm from right ovarian  Perform Right
Salphingooforectomy cut, clamp, suture mesosalphing and right infundibulopelvicum and ovarii
propium ligamentum  PA

Uterine size and shape normal , left ovarian was normal

On exploration  perform Total Hysterectomy Left Salphiongooforectomy

Right and left rotundum ligament clampped and cut

Plica vesicouterina opened

Opening left and right anterior broad ligament,

Right Left round ligament clampped and cut

left and right uterine artery cut

Vaginal stump cut then sutured

Perform partial omentectomy

Perform bilateral limfadenectomy

Perform stab wound drain

17.30 PM: Operation was finished.

Bleeding intraoperative 700 cc, urine 200 cc clear.

Date of visit/ hospitalized 08-07-2019

Identity

Name Ms. Reisty Anggredevi

Med Rec/ Reg 1129837

Age 29-09-2006 (12 yo)

Address Muara Enim

Operator Dr. H. P. Agustiansyah, SpOG(K), MARS

Resident -

Anamnese CC: Abdominal enlargement

08-07-2019

Since ± 4 months ago patient complained abdominal enlargement,

pain (+) but rare.

Patient went to PT BA hospital at Tanjung Enim and referred to

Graha Specilaist Moh. Hoesin hospital.

H/ vaginal bleeding (-), H/ dyschezia (-), H/ decreased of appetite

and weight (-), urinate and defecate in normal limit.

Menstrual: Menarche 12 yo, menstrual cycles regular 28 days, days,

for 7 days, LMP : August 19th 2019

Marrital : Not married yet

Obstetric: P0A0

Prior operation: -

Past medical ilness : -

Physical Examination Physical examination :

BP : 110/80 mmHg, HR: 80x/m, RR: 20x/m, T: 36,5ºC, weight 160

cm, height 51 kg
 General status : Normal

Gynecologic status :

Abdomen : convex abdomen, symmetric, mass (+), cystic , mobile,

sized 17x8 cm, upper border was 1 finger above umbilical, right
border was right LMC, left border was left LMC, below border was
symphysis, abdominal tenderness (-), free fluid sign (-).

Inspeculo and VT: didn’t done

RT : didn’t done because patient refused

US (NS) 30-08-2019 Uterine was AF, shaped and sized in norml limit, 6.2x2.5 cm.

There was cystic mass at left adnexa sized 17.7 x 7.6 cm,
multiloculare, papillary (+).

Right ovarian in normal limit.

Liver and both of kidney in normal limit.

Ascites (-)

C/ Left cyst ovarian neoplasm with multiloculare and papillary

Laboratory examination Hb 12.3 g/dL, WBC 8.300/mm3, PLT 369.000/µL, BSS 86 mg/dL,
29-08-2019 SGOT 14 U/L, SGPT 115 U/L , Albumin 4.5 g/dL, BSS 106 mg/dL,
Cr 0.74 mg/dL, Ur 24 mg/dL, AFP 1.11 ng/mL, CA 125 16.4 U/mL
CEA 0.70 ng/mL

Diagnosis and Planning Diagnosis:

Left cyst ovarian neoplasm malignancy was suspected

Planning:

Conservative Surgical Staging 02-09-2019

Intraoperative Finding

10.55 AM: Operation started.

Patient on supine position and under spinal anesthesia.

Aseptic and antiseptic were done on operating area.

Operation site narrowed with sterile cloth. Then continue with mediana incision . On exploration
was found :

Multiloculare cyst mass with size 18x12 cm from left ovarian  Perform Left
Salphingooforectomy cut, clamp, suture mesosalphing and right infundibulopelvicum and ovarii
propium ligamentum  PA

Uterine size and shape normal , rightovarian was normal

On exploration  perform Partial omentectomy

12.30 AM: Operation was finished.

Bleeding intraoperative 400 cc, urine 200 cc clear.