Pediatric Surgery Report

Friday, October 23rd 2020

Sinung/Yasmin/Galih/Oya/Anita/Stella/Wirda/Faris
 Patient Distribution Table

No Name Sex Age Diagnose Problem Management Note

1 Muhammd M 12 years Chronic constipation (K59.00) Bloating tummy Management : Emergency
Sidqi old dd/ Suspicious Hirschprung’s Nothing per oral
disease (Q43.1) • Decompression with NGT 12 Fr
• IVFD Ringer Lactate 1.580 ml/24 hours
• Ceftriaxone inj 2 x 1 g IV
• Metronidazol inj 3 x 240 mg IV
• Paracetamol inj 4 x 480 mg IV
• Rectal washout  effective  Start diet
• Plan for Barium enema + Biopsy electively
2 Mrs Elan F 4 days Anorectal malformation Have no anus Management : Emergency
Lisnawati’s old Cloacal type (Q42.3) + • Nothing per oral
Baby Moderate dehydration (E86.0) • Decompression with 0GT 10 Fr
+ Neonatal • IVFD Ringer Lactate loading 40 ml for 20 minute
hyperbilirubinemia (P59.9) • D : 8% x 1.000 x 2 kg = 160 ml
• M : 100 x 2 kg = 200 ml
• First 8 hour = 1/2D + 1/3M – L = 80 ml + 67 ml – 40
= 107 ml/8 hours ≃ 13,4 ml/hours
• Second 16 hour = 1/2D + 2/3M = 80 ml + 133 ml =
213 ml/16 hours ≃ 13,4 ml/hours
• Ceftriaxone inj 2 x 100 mg IV
• Paracetamol inj 4 x 40 mg IV
• Plan for divided colostomy (46.1)
 Patient Distribution Table

No Name Sex Age Diagnose Problem Management Note

3 Mrs Furi M 2 days Esophageal atresia with
Lestari’s Baby old Tracheoesophageal fistula
(Gross type C + Waterstone
type B) (Q39.0) + Anorectal
malformation without fistula
(Q42.3) + Bronchopneumonia
(J18.0)
Have no anus Management : Emergency
and • Nothing per oral
hypersalivation • Thermoregulation
• O2 nasal canule 0,5 L/m
• Body up 45°
• Periodic suction
• Decompression with 0GT 10 Fr
• IVFD Ringer Lactate 240 ml/24 hours
• Folley catheter no 6 Fr insertion
• Ceftriaxone inj 2 x 120 mg IV
• Paracetamol inj 4 x 48 mg IV
• Plan for Gastrostomy (43.1)
• Plan for Divided colostomy (46.1)
 Patient Distribution Table

No Name Sex Age Diagnose Problem Management Note

4 Hafizah M 3 days Anorectal Malformation No complaint Post Operative Instruction : Anturium
Mumtala old without fistula (Q42.3) + • Nothing per oral
Syarifah Suspected down syndrome • IVFD TPN 8.51 ml/jam (D10% 176 ml, D40% 16 ml,
that have been perfomed NaCl3% 9.8 ml, KCl 7.46% 2.5 ml)
Divided colostomy (46.1) POD • Aminosteril 6% 40,8 cc/jam
1 • Cefotaxime 2 x 120 mg IV
• Metronidazol 3 x 25 mg IV
• Paracetamol 3 x 50 mg IV
• Stoma care
P:
• -
5 Amelia Despita F 8 years Umbilical granuloma (P83.81) No complaint Post operative instruction : Kenanga 1
old that have been performed • Fasting
Laparoscopic diagnostic • IVFD KaenMg3 1.540 ml/24 hours
(54.21) + Excision of the • Ceftriaxone 2 x 1 gr IV
Umbilical granuloma (54.3) • Paracetamol 3 x 440 mg IV
POD 1 • Wound care
P:
• Feeding
3 Patients

EMERGENCY PATIENTS
 Muhammd Sidqi / M /12 years old (06-10-2008) / BW : 24 kg
MR : 0001865504 – 20024018 / ADM : 23-10-2020 / Emergency
Consultant : dr. Kurniawan Oki, Sp.BA
Chief complaint : Distended abdomen

Patient suffered from distended abdomen since 5 months prior to admission. The distention was in the whole
area of the abdomen. The patient had small amount of soiling defecation 2-3x/day on the last week, liquid
consistency and smoul odor. History of nausea and vomiting were denied. The patient had history of constipation
since 1 year old, frequency of bowel movement was 2-3x/week. History of passing hard stool was denied. History of
painful defecation was denied. History of laxative application for defecation was denied. There was no history of
fever. Complaint of micturition was denied. There was no history of late meconium passage. History of obstipation
during newborn and infancy were denied.
Due to these complains, patient went to Cimareme hospital, but due to economical status, patient was then
taken to Cibabat hospital 1 day ago. Patient was then referred to Hasan Sadikin Hospital for further management.
 Physical examination

Consiousness : Compos mentis, Pulse : 95 x/min, Respiration : 24 x/min, Temperature : 36,4°C

Head : Conjunctiva not anemic, sclera not icteric, moist mouth and lips mucosa.
NGT : + 5 ml, yellowish
Thorax : Symmetrical shape and movement, There was no retraction
Cor : Regular heart sound, there was no murmur
Pulmo : Vesicular breathing sound right = left, there was no rales, there was no wheezing
Abdomen :
I : distended, there was visible bowel contour movement on abdominal wall, no hyperemic, no venectation.
A : increase bowel sound.
P : soft
Anal region : bruishes (-), skin tags (-)
Digitar rectal examination : Strong anal sphingter, no collapse rectal ampulla, smooth mucosa
Hand glove : feces +, there was no blood
Extremities : Warm, Capillary refill time < 2”
Clinical picture
Clinical picture
 Clinical picture

Feces NGT
 Laboratory result

• Hb : 13,5
• Ht : 39,6
• L : 9.130
• Tr : 539.000
• Diff Count :
• Bas/Eos/Stem/Seg/Lim/Mon
0/3/0/59/29/8
• RBG : 79
• Na : 138
• K : 4,3
• Alb : 3,72
• Covid : non reactive.
 Thorax X-ray
23-10-2020, Hasan Sadikin hospital
 Abdominal X-ray
23-10-2020, Hasan Sadikin hospital
 Abdominal X-ray
29-05-2020, Karisma Cimareme hospital
Working diagnosis :
Chronic constipation (K59.00) dt Susp Hirschprung’s disease (Q43.1) dd/ functional constipation.

Management :
• Nothing per oral
• Decompressive NGT 12 Fr
• IVFD Ringer Lactate 1580 ml/24 hours
• Ceftriaxone inj 2 x 1 g IV
• Paracetamol inj 4 x 480 mg IV
• Rectal washout  effective  Start diet
• Plan for further rectal washout in the ward and contrast enema + rectal biopsy.
 Clinical picture

Pre Washout Post Washout

 Clinical picture

Pre Washout Post Washout

 Mrs Elan Lisnawati’s Baby / F / 4 days old (19-10-2020) / BW : 2.050 gram
MR : 0001865721 – 20024033 / ADM : 23-10-2020 / Emergency
Consultant : dr. Kurniawan Oki, Sp.BA
Chief complaint : Having no anus

Patient suffered from having no anus which was noticed since birth. There was feces mixed with urine. The
feces and urine were discharged from the same hole. The complaint was accompanied by vomiting since 2 days
previously, 5x/day, the vomit was yellowish, and turned greenish since 1 day ago. The patient also suffered from
abdominal distention since 1 day previously. There was no history of fever.
Patient was delivered by P2A0 mother, term infant (36-37 weeks), gemelli, spontaneous delivery helped with
midwife at Livasya hospital. Baby spontaneously cry, birthweight 2.200 grams, there was no bluish in mouth and
fingers when the baby cried. The twin had intra uterine fetal death. Mother had routine antenatal care by midwife,
had ultrasound once and was said to be normal.
Because of the complaint, patient went to Cideres hospital, then refered to Hasan Sadikin Hospital for further
management.
 Physical examination

Consiousness : State 5, Heart rate : 150 x/min, Respiration : 47 x/min, Temperature : 36,4°C, SpO2 98% room air
Head : Sunken great fontanel, conjunctiva not anemic, sclera not icteric, dry mouth and lip mucose
OGT : + 2 ml, yellow
Thoraks : Symmetrical shape and movement, there was no retraction
Cor : Regular heart sound, there was no murmur
Pulmo : Vesicular breathing sound right = left, there was no ronchi, there was no wheezing
Abdomen :
I : Slightly distended, there was bowel contour at abdominal wall, there was no bowel movement, no hyperemic, no venectation
A : Normal bowel sound
P : Soft
Genitoperineoanal : single orifice +, anal dimple +, anal canal (-)
Extremity : Warm, Capillary refill time < 2”
Clinical picture
Clinical picture

Single orifice
 Clinical picture

Urine OGT
Clinical picture
Clinical picture
 Laboratory result

• Hb : 15,4 • Ureum : 72,1

• Ht : 43,7 • Kreatinin : 1,32
• L : 15.610 • Natrium : 145
• Tr : 379.000 • Kalium : 3,0
• PT : 13,5 • SGOT : 43
• APTT : 1,22 • SGPT : 10
• INR : 26,2 • Total Bilirubin : 14,640
• GDS : 92 • Indirect Bil : 14,014
• CRP kuantitatif: 0,1 • Direct Bilirubin : 0,626
 Thorax X-ray
23-10-2020, Hasan Sadikin hospital
 Abdominal X-ray
23-10-2020, Hasan Sadikin hospital
 Abdominal X-ray
22-10-2020, Cideres hospital
 Abdominal X-ray
22-10-2020, Cideres hospital
Working diagnose :
Anorectal malformation Cloacal type (Q42.3) + Moderate dehydration (E86.0) + Neonatal hyperbilirubinemia (P59.9)
+ hypoalbuminemia (E88.0)

Management :
• Nothing per oral
• Decompression using 0GT 10 Fr
• IVFD Ringer Lactate loading 40 ml for 20 minute
– D : 8% x 1.000 x 2 kg = 160 ml
– M : 100 x 2 kg = 200 ml
– First 8 hour = 1/2D + 1/3M – L = 80 ml + 67 ml – 40 = 107 ml/8 hours ≃ 13,4 ml/hours
– Second 16 hour = 1/2D + 2/3M = 80 ml + 133 ml = 213 ml/16 hours ≃ 13,4 ml/hours
• Folley catheter no 6 Fr insertion
• Ceftriaxone inj 2 x 100 mg IV
• Paracetamol inj 4 x 40 mg IV
• Plan for divided colostomy (46.1)
 Mrs Furi Lestari’s Baby / M / 2 days old (22-10-2020; 15.42 WIB) / BW : 2.409 gram
MR : 0001865740 – 20024036 / ADM : 24-10-2020 / Emergency
Consultant : dr. Kurniawan Oki, Sp.BA
Chief complaint : Having no anus and Hypersalivation

The parents was informed after birth that their baby had no anus. There wasn’t any meconium discharged from
other opening neither was urine mixed with meconium. The complaint was accompanied by bloating abdomen.
There was also hypersalivation. This complaint was accompanied by shortness of breath. There was no complaint of
vomiting. There was no fever, there was no complaint in micturition.
Patient was delivered by P1A0 mother, term infant (37-38 weeks), cesarian section delivery due to
polyhidramnion at Hermina Arcamanik hospital. Baby was spontaneously cried, APGAR score was 6/8, birthweight
2.527 grams, there was no bluish in mouth and fingers when the baby cried. Mother had routine antenatal care by
midwife, had ultrasound once and said there was polyhidramnion.
Due to these complains, patient then refered from Hermina Arcamanik hospital to Hasan Sadikin Hospital for
further management.
 Physical examination

Consiousness : State 4, Heart rate : 152 x/min, Respiration : 50 x/min, Temperature : 37,2°C, SpO2 91% room air  98% with nasal
canule oxygen 0,5 lpm
Head : Flat great fontanel, conjunctiva not anemic, sclera not icteric, wet mouth and lip mucose, hypersalivation (+)
OGT : + 4 ml, clear  OGT stopped at 11 cm
Thorax : Symmetrical shape and movement, there were retraction on suprasternal and intercostal
Cor : Regular heart sound, there was no murmur
Pulmo : Vesicular breathing sound right = left, there was no ronchi, there was no wheezing, there was crackles.
Abdomen :
I : Slightly distended, there was bowel contour at abdominal wall, there was no bowel movement, no hyperemic, no venectation
A : Normal bowel sound
P : Soft
Anoperineal : Anal dimple +, anus -
Extremity : Warm, Capillary refill time < 2”
Clinical picture
Clinical picture
 Clinical picture

Urine OGT
Clinical picture
Clinical picture
 Laboratory result

• Hb : 17,1 • Ureum : 32
• Ht : 46,9 • Kreatinin : 1,29
• L : 12.450 • Natrium : 135
• Tr : 219.000 • Kalium : 4,5
• PT : 16 • SGOT : 91
• INR : 1,46 • SGPT : 30
• APTT : 38,6 • Total Bilirubin : 10,807
• GDS : 87 • Indirect Bil : 10,295
• CRP : 0,15 • Direct Bilirubin : 0,512
 Thorax X-ray
24-10-2020, Hasan Sadikin hospital
 Abdominal X-ray
24-10-2020, Hasan Sadikin hospital
 Abdominal X-ray
23-10-2020, Hermina Arcamanik hospital
Working diagnosis :
Esophageal atresia with Tracheoesophageal fistula (Gross type C + Waterston type B) (Q39.0) + Anorectal
malformation without fistula (Q42.3) + Bronchopneumonia (J18.0) + Neonatal hyperbilirubinemia (P59.9)

Management :
• Nothing per oral
• Thermoregulation
• O2 nasal canule 0,5 L/m
• Body up 45°
• Periodic suction
• Decompression with 0GT 10 Fr
• IVFD Ringer Lactate 240 ml/24 hours
• Folley catheter no 6 Fr insertion
• Ceftriaxone inj 2 x 120 mg IV
• Paracetamol inj 4 x 48 mg IV
• Plan for Gastrostomy (43.1)
• Plan for Divided colostomy (46.1)
2 Patients

POST OPERATIVE PATIENTS

 Hafizah Mumtala Syarifah / M / 3 days old (20-10-2020) / BW : 2.450 gram
MR : 0001865330 – 20024005 / ADM : 22-10-2020 / Anturium
Consultant : dr. Emiliana Lia, Sp.BA(K)
Patient was hospitalized at Anturium ward on working diagnosis : Anorectal Malformation without fistula (Q42.3) +
Mild dehydration (E86.0) + Suspected down syndrome

Patient have been done Divided colostomy (46.1) on October 23rd 2020, surgeon : dr. Fransisca

Intra operative findings :

• There was distended sigmoid colon.
• Divided colostomy was performed in proximal sigmoid colon.
Hafizah Mumtala Syarifah / M / 3 days old (20-10-2020) / BW : 2.450 gram
Divided colostomy (46.1)
October 23rd 2020, operator : dr. Fransisca
Hafizah Mumtala Syarifah / M / 3 days old (20-10-2020) / BW : 2.450 gram
Divided colostomy (46.1)
October 23rd 2020, operator : dr. Fransisca
 Hafizah Mumtala Syarifah / M / 3 days old (20-10-2020) / BW: 2.450 gram
MR : 0001865330 – 20024005 / ADM : 22-10-2020 / Anturium
Consultant : dr. Emiliana Lia, Sp.BA(K)
During our duty time

S : No complain
O : Consciousness : Alert, Heart rate : 142 x/min, Respiratory rate: 44 x/min, Temperature: 36,7℃
OGT : no production
Abdomen : flat, soft, weak bowel sound
Stoma : Vital, no production
Urin output : 1,6 ml/kgBW/hour

Laboratory result (23-10-2020) :

Hb/Ht/L/Tr : 18.7/50.7/6960/76000
Na/K : 136/6.3
 Hafizah Mumtala Syarifah / M / 3 days old (20-10-2020) / BW: 2.450 gram
MR : 0001865330 – 20024005 / ADM : 22-10-2020 / Anturium
Consultant : dr. Emiliana Lia, Sp.BA(K)
A : Anorectal Malformation without fistula (Q42.3) + Suspected down syndrome that have been perfomed Divided
colostomy (46.1) POD 1

Post Operative Instruction : P:

• Nothing per oral •-
• IVFD TPN 8.51 ml/jam (D10% 176 ml, D40% 16 ml,
NaCl3% 9.8 ml, KCl 7.46% 2.5 ml)
• Aminosteril 6% 40,8 cc/jam
• Cefotaxime 2 x 120 mg IV
• Metronidazol 3 x 25 mg IV
• Paracetamol 3 x 50 mg IV
• Stoma care
 Amelia Despita / F / 8 years old (04-12-2011) / BW : 22 Kg
MR : 0001860639-20023986 / ADM 21-10-20 / Kenanga 1
Consultant : dr. Vita Indriasari, Sp.BA(K)
Patient was hospitalized at Kenanga 1 ward on working diagnosis : Suspected sinus omphalomesenteric remnant
(Q43.0) dd/ Patent ductus urachus (Q64.4)

Patient had been performed Laparoscopic diagnostic (54.21) + Excision of the Umbilical granuloma (54.3) on
October 23rd 2020, surgeon : dr. Vita Indriasari, Sp.BA(K)

Intra operative findings :

• There were no urachal remnant and omphalomesenteric remnant.
• There was umbilical granuloma.

Post Operative diagnosis : Umbilical granuloma (P83.81)

 Amelia Despita / F / 8 years old (04-12-2011) / BW : 22 Kg
Laparoscopic diagnostic (54.21) + Excision of the Umbilicalis granuloma (54.3)
October 23rd 2020, with operator : dr. Vita Indriasari, Sp.BA(K)
 Amelia Despita / F / 8 years old (04-12-2011) / BW : 22 Kg
Laparoscopic diagnostic (54.21) + Excision of the Umbilicalis granuloma (54.3)
October 23rd 2020, with operator : dr. Vita Indriasari, Sp.BA(K)
 Amelia Despita / F / 8 years old (04-12-2011) / BW : 22 Kg
MR : 0001860639-20023986 / ADM 21-10-20 / Kenanga 1
Consultant : dr. Vita Indriasari, Sp.BA(K)
During our duty time :

S: No fever, no vomiting
O: Consciousness : Alert, Heart rate: 88 x/minute, Respiratory rate: 20 x/minute, Temperature: 36.5◦C, PAS : 2
Abdomen : flat, soft, normal bowel sound
Operation wound : no active bleeding

A : Umbilical granuloma (P83.81) that have been performed Laparoscopic diagnostic (54.21) + Excision of the
Umbilical granuloma (54.3) POD 1

Post operative instruction : P:

• Fasting • Feeding
• IVFD KaenMg3 1.540 ml/24 hours
• Ceftriaxone 2 x 1 gr IV
• Paracetamol 3 x 440 mg IV
• Wound care
THANK YOU