4 FG Achille K> 1. By YULLRS'Z BillHUl Uchi! ZHLY pi. HOSPITAL ush. 'lml! name l1.llmp P1m: Is Yossi m.

111 l: mye; to () n fllkrltspi 107150, Moscow, street Losinostrovskaya, 45 Tel. 8 (499) 167-32-48, 8 (499) 167-01-70, 8 (499) 167-01-69 Fax: 8 (499) 167-32-27 E-mail: info@presidentclinic.ru. WEB: www.presidentdinic.ru Epicrisis vypisnoy IS 3720 Code of Aung Myo Min Date of Birth 06/02/1988 Department: SURGICAL number 1 Name Patient: Aung Myo Min Date of birth: 06/02/1988 ('22) Date of admission: 25.04.2011 Date of departure: 05.05 2011 The movement of a hospital: Department of the date of receipt of the date of transfer (discharge) of bed days Anesthesia. Resuscitation and 04/25/2011 26/04/2011 1 SURGERY 26/04/2011 05/05/2011 1 9 Total 10 Dkegnoz sent the organization: Fr. appendicitis? Dilpyuz: kg / canonical-zakpyuchitel =. / main: K25.5 Ulcer of stomach ezn ball. Perforation. Delimited peritonitis (acute) Complaints: intensive vyrazhenkge pain upper abdomen and right iliac region, nausea, dry mouth. History of the disease: yuntakt made difficult with the patient ^ e foreigner - Mya-ma). From the words accompanying the ill 25/04/2011 around 6:00 am when there were aching in the area that zligastralonoy by 10:00 intensified, became intense, spread to the right side of the abdomen. Pain syndrome and remains steadfastly maintained. In view of the above media on 04/25/2010 hospitalized in KB UDP. Ulcerative history denies. Objective status: Marital status-s patient: moderate. Temperature: 36.8. Body type: normostenicheskaya, correct position of the patient: active. Skin and mucous membranes: the skin dark, slimy sklesy and clean .. Eruption no. Peripheral lymph nodes: not enlarged. Osteo-my1_e - th system: without deformation. Peripheral edema, no. Status localis-Tongue dry, coated with white bloom. Swollen belly. On palpation tense, sharp pain in the epigastrium. " ~ Savoy iliac region, which is defined by a positive symptom-SHCHetkina Bljumberga. Symptoms Sitkovskiy Rovzinga, Bartome-Michelson questionable because of severe muscle bans. Peristalsis normally listen. Gaza depart. Urination independent. Chair on the eve of normal. These laboratory studies: 25/04/2011.Gemoglobi- on the analyzer (blood), 17-15 h: 149 g / l, hematocrit: 0.45 g / l, leukocyte count at March 10 analyzer 10l9 / l, erythrocyte count on the analyzer: 4.83 10l12 / l of blood 25/04/2011.Gruppa AB IY) fourth., Rh affiliation: positive., Antirezusnye antibodies: not found. 25.4.2011. Mochi.Epitely flat sediment microscopy: slightly, WBC: 2-3, RBC: 1-2 25.4.2011. Kroei Amylase (serum) 17-15 h: 74 ME 26.4.2011. Ob_iy.Tsvet Urinalysis: a straw-yellow, Transparency: transparent, Specific weight: 1.017 kg / l, reaction (pH): 5.5 Protein: - g / l glucose (sugar): 11 mmol / L , Ketone bodies: 4 mmol / L, bilirubin: - n / s, Urobili-ogen: normal Eu / dl, Nitrite: - n / s, the transitional epithelium: <1 n / s, Leukocytes: 2 n / s, Red Blood Cells 3 n / h. Mucus little p / h 26/04/2011.HBs Aq: negative, Anti-HCV: negative. 26.4.2011. Antibodies to HIV but have not been found, RPR with kardiolipinovym antigen: negative 03/05/2011.Krovi analysis razvernutyy.Leykotsity WBC: 4.7 10l9 / l, RBC RBC: 6.99 10l12 / l, hemoglobin HGB: 145 g / l. The color index: 0.62 , Hematocrit HCT: 0.462 l / l, platelets PLT: 337 10l9 / l Trombokrit PCT: 0.307 10l9 / l,-s average contains hemoglobin MCH: 20.8 pg, mean platelet volume MPV: 9.1 fl. The average volume of Erie grotsita MCV: 66 fl. Average end-I

5 ICSU hemoglobin 314 g / L, platelet anisocytosis index PDW: 16.5%, index of anisocytosis of erythrocytes RDW: 14.1%, Neutrophils% NEU: 35.8%, Lymphocytes% LYM: 40.7:: Monocytes% MON: 8.2%, Eosinophils% EOS : 13.5% Basophils% in AS: 1.0%, large

immature cells% LIC: 1.1%, atypical lymphocytes% ALY: 2.5%, neutrophils # NEU: 1.67 10l9 / l, lymphocytes # LYM: 1.89 10l9 / l, monocytes # MON : 0.38 10l9 / l, eosinophils # EOS: 0.63 10l9 / liter. Basophils # BAS: 0.08 10l9 / L Large immature cells # LIC: 0.05 10l9 / liter. Atypical lymphocyte # ALY: 0.12 10l9 / l, ESR 10 mm / h, stab neutrophils: 3.0%, segmented neutrophils: 38.0%, eosinophils: 14.0% Basophils: 0.0%, lymphocytes: 33.0%, monocytes: 12.0% anisocytosis: + poikilocytosis +, hypochromia +

03/05/2011.Belok total: 79.48 g / l, albumin: 43.7 g / l, blood urea: 3.3 mmol / L, total cholesterol: 4.38 mmol / l, blood glucose: 4.37 mmol / L, serum iron: 15.6 mol / L, ALT activity: 64.6 ME, ACT Activity: 56.0 ME, Gamma-GT activity: 36.8 ME electrolytes (potassium, sodium) in the serum

In serum potassium: 3.9 mmol / L in serum sodium: 129.00 mmol / l

03/05/2011.Trombinovoe time: 17.4 sec, APTT: 32.3 sec, fibrinogen (DFb'g): 3.9 g / liter. Prothrombin time: 11.7 seconds

These instrumental studies:

P-graphy of the abdomen-Review (04/25/2011);

On the plain film of the abdomen under the right dome of the diaphragm is determined by narrow strip of bubble free gaza.Gazovy stomach is transparent, in the stomach a large quantity of liquid soderzhimogo.Umerennaya pneumatization of the small intestine in ileo-tsekalnoy area CONCLUSION: Suspicion of perforation of a hollow body P-graphy of the chest in a second projection

Visible sections of lung fields without focal and infiltrative changes. Pulmonary diffuse pattern is moderately enhanced. The roots of the lung structure. Diaphragm located at one edge

higher than usual. Lateral pleural sinuses free shadow of the heart is not enlarged in size Summary (26/04/2011): focal and infiltrative changes in the visible regions of the lung fields were found. Consultations:

Consult a doctor specialist physiotherapist (26.4 2011) Consultation with specialist physiotherapists (04/26/2011)

Provides treatment: Drug treatment: 40 mg Losek 2p / d \ in number 7, Cefotaxime 1.0 Sp / d \ in number 7, 2p Metrogil 500 mg / d \ in the cap. Number 5. Procedural treatments:

LH in the surgery 7 min 1 time per day fullscreen. 8-10 min, 10-12 min, 15 min. Therapeutic massage is a classic 1 times a day massage of the chest in n / a period number 2. Mioelektrostimulyatsiya 2 fields in the House of a once-daily bowel Daily. 3. Operations: 25.04.2011 38 surgery: Laparoscopy, laparotomy, suturing perforated ulcers, drainage of abdominal cavity.

Features surgical intervention: protocol operations 38: After 12 hours of illness. After 1 h 40 min. of income.

The 1st point above the belly button with a needle Veress imposed karboksiperitoneum and put the laparoscope. At revision: in the right iliac region, in the pelvis and right lateral canal to 100 ml of clear straw-yellow exudate. In podpechenochnom space in place of the transition piloroduodenalnogo turbid effusion with fibrin, there is flow of gastric contents. In view of these P-graphy of the abdominal cavity (the presence of a crescent of air in the right upper quadrant), the clinical picture is regarded as a perforated ulcer piloroduodenalnogo transition delimited peritonitis. The operation moved to laparotomy. Laparoscope and trocar removed. Completed upper-middle laparotomy. At revision: on the front wall of the stomach pyloric channel 2 cm above the pyloric sphincter is palpated ulcerative defect with hard-edged diameter 1.5-1.8 cm from the center sprocket hole diameter of 0.8 cm, which goes through

the contents of the stomach. Produced by suturing the defect of the stomach wall by Oppel-Polikarpov: perforation sutured in a transverse direction through all layers of interrupted sutures separate thread rezorba 3 / 0, then the perimeter of the defect additionally filed separate sero-muscular sutures similar thread a strand of omentum, densely covering the area of the ulcer . With the help of vacuum suction evacuated exudate and fibrin podpechenochnogo of space and the effusion of the pelvis. After which the abdomen is thoroughly rinsed with 5000ml of warm saline solution. Hemostasis - dry. Drainage in the pelvis wound through kotrapperturu in the right iliac region. Drainage area to the sutured ulcer in podpechenochnoe space wound through kontrapperturu in the right upper quadrant. Anterior abdominal wall wound sutured double thread 0 PDS through all layers. Sutures on the skin. Iodine. The alcohol bandage.

Results of treatment: a smooth post-operative period. Primary wound healing

stretching. Drains are removed on 3-5th day. Sutures were removed on the 8-9th sutik. In udvoletvoriteltmno

vpyisyvaetyas state from the hospital under observation hiurga clinic.

Recommendations for further treatment: 1. Diet 1 (fraction 4-5-kratnoye food otvaranya

food, avoid fried, pepper dish).

2. Goranichenie physical activity for 2-3 months.

6
3. Wearing banadazha 1 month. 4. Omeprazole 20 mg of 2p / d for 20 min. Ride up to 3-4 weeks. 5. Venter, 0.5 g 3-4 p / d for 20 minutes before meals for 3-4 weeks. 6. Control endoscopy after 6 months.

7. Observation of a gastroenterologist. 8. Rates of antiulcer therapy spring and autumn, 2 times a year. The outcome of the disease: with recovery Employability: temporarily lost Aims: Observation GP Student certificate will be issued series _

number From Signatures by attending physician: Head of Department: / Surma AS / / Altunin AI /