EMERGENCY CASE REPORTS

Wednesday, August 26th 2020

SURGERY DEPARTMENT

EMERGENCY ROOM
Wahidin Sudirohusodo General Hospital
Makassar
 Name : Tn. AE Sex : Male
Age : 58 yo DPJP :RL

Chief complain : Abdominal distended

History taking : This condition has been suffered since 1 week before admitted to
hospital. There was history of difficult to defecation. There
were history of nausea and vomiting. There was history of
abdominal pain if patient want to defecation. There was
change bowel habit since 2 years ago. History defecation like
goat’s fesses (+). No defecation since 4 days ago and flatulen
since 1 days ago. Lost of body weight about 10 kg in 1 year.
Micturie was normal, hematuri (-)
No DM, No HT
 General Status
Severe illness / Poor nourish / conscious

Vital Sign
BP : 120/80 mmHg
HR : 90x/mnt, strong, reguler,
RR : 20x/mnt, symmetric L=R, thoracoabdominal
T(Ax) : 36,5°C
 Local status
Abdomen :
I: Convex, followed breath motion, color same with vicinity, tumor
mass (-), darm contour (+), darm steifung (+)
A: bowel sound (+) increase, metallic sound (+)
P: Soft (+), tumor mass (+) LUQ, tenderness (-)
P: Tapping pain (-), Tympani
Rectal examination :
Sphincter ani was tight
Mucosa was smooth
Ampulla was collaps
Tumor mass (+) 3 cm from anal verge
Circular and Lump
Gloves : Feces (-), slime (-), blood (+)
 CLINICAL DIAGNOSIS

Ileus Obstruktif due to Tumor Recti 1/3 Distal

Laboratory Result
WBC : 9,1 x 103 / μL Natrium : 143 mmol/l

RBC : 2,98 x 106 / μL Kalium : 4,6 mmol/l

HGB : 7,1 g/dL Chloride : 105 mmol/l

HCT : 28,1 % IgM : Nonreactive

PLT : 392 x 103 / μL IgG : Nonreactive

PT/APTT : 12/21

Blood Sugar : 112 mg/dl

Ureum : 40 mg/dl

Creatinin : 0,8 mg/dl

SGOT/SGPT : 71/31 u/l

CT Scan Abdomen
CT Scan Thorax
WORKING DIAGNOSIS :  Ileus Obstruction due to Tumor Recti 1/3 Distal
 Anemia

MANAGEMENT : • IVFD
• Insert NGT Decompressi
• Insert Urinary catheter
 Medicaments
 Screening Covid 19
Transfusi PRC 2 Bag
 Report to senior Digestive Surgeon :
Advice : Urgent Laparatomy Colostomy
Diversi Feces
 Operating Procedure
• Patient laid in supine position under GA.
• Sterilization and draping procedure
• Midline incision 3 fingers above umbilicus until 3 fingers above
simphysis pubis, deepen until peritoneum, seen dilatation Colon
• Identification solid organ, nodul in hepar (-)
• Seen Tumor rectum 1/3 distal and fixed to posterior wall of bladder
 unresectable
• Decide to have colostomy double barrel in sigmoid colon
• Spooling to proximal and distal segmen sigmoid colon
• Control bleeding
• Close operating wound layer by layer, apply 1 drine in cavum pelvis
• Do biopsi per rectum
• Operation finished
POST OP DIAGNOSIS : - Ileus Obstruction due to Tumor Recti
1/3 Distal
- Anemia

PROGNOSIS : Dubia

FOLLOW UP : Vital Sign

Viabilitas Stoma
Wound Care
THANK YOU