A/F/5yo

83.54.52
Chief Complaint : Red current jelly stool
It had been suffered by the patient since 5 days
before admitted to Adam Malik Hospital. The patient
cried intermittently with silent episode. Abdominal
distention was found since 5 days ago. History of
greenish vomitting since 2 days ago. History of fever
was not found. History of abdominal massage was
not found. Micturition was normal. History of past
illness was not found. History of medication
antipyretic. History of immunization was clear.
Patient with history of normal delivered, aterm,
spontaneously crying, no history of late to troughout
meconium, with birth of body weight 2.800 gr.
 Present State
• Awareness : Alert, crying loudly
• BP : 100/60 mmHg
• HR : 92 bpm
• RR : 22 tpm
• Temp : 36.8 °C
• BW : 15 kg
 Generalized State
• Head : No abnormality was found
• Neck : No abnormality was found
• Chest : No abnormality was found
• Abdomen : in localized state
• Genitalia : female, no abnormality was found
• Extremities : No abnormality was found
 Localized State

Abdomen :
• I : Symmetrical, distention (+), visible
bowel movement (+), visible bowel
contour (+)
• A : Peristaltic was increased, metallic
sound (+)
• P : Muscular rigidity (-), dance’s sign
(+), banana shaped mass (+)
• P : hypertympani, liver dullness (+)
DRE :
• Perineum was normal, tight anal
sphincter tone, smooth mucosal
surface, ampula was collapsed,
pain (-)
• Gloves : feces (-), blood (+), mucous
 Laboratorium Finding
• Hb/Ht/Wbc/Plt : 12.8/35/13.850/728.000
• Glucose adr : 90
• Na/K/Cl : 135/3.8/99
• Swab Antigen Covid-19 : Non-reactive
Chest X-Ray
Abdominal X-Ray
 Working Diagnose

Total mechanical bowel obstruction d/t Susp.

intussusception
 Treatment At The Emergency
Room
• Nil per mouth
• Insertion of NGT  came out greenish fluid 50 cc
• IVFD Crystalloid  IVFD Ringer lactate 20 dpm
micro
• Insertion of urinary catheter  came out clear
yellow 60 cc, UOP 7.5 cc/hr
• Antibiotic inj.  Cefotaxime inj. 500 mg
• Analgesic inj.  IVFD Paracetamol 250 mg drips
Plan :
Exploratory Laparotomy
 At The Operating
Theatre
• Patient in supine position, under general ETT
anesthesia, aseptic and antiseptic procedure were
performed.
• The transverse supraumbilical incision was made, cutis,
subcutaneous, linea alba, peritoneum was opened.
Came out serous fluid about 30 cc, small bowel was
dilated.
• Identification of small bowel from treitz ligament,
there was intraluminal mass with ileo-ileal
intussusception, 200 cm from Treitz ligament and 40
cm from ileocaecal valve with solid consistency,
immobile, size 3x3x2 cm. Then found a mass on ileal
mesenterial solid consistency, immobile, size 5x4x3
cm.
• Identification of large bowel from ileo caecal valve to
rectum, large bowel was collapsed. There was multiple
lymph node palpated at the ileal mesenterial.
• Identification of liver, there was not palpable node.
• Decided to perform ileo-ileal
resection, 5 cm from proximal
and distal mass. Lymph node was
dissected.
• Ileostomy was performed with
fixation to fascia with 8 cardinal
direction with using non-
absorable material.
• The specimen was brought to
laboratory for histopatology
examination.
• Bleeding was controlled,
abdominal cavity was rinse with
normal saline until clean.
• The surgical wound was closed
layer by layer with leaving 1
drainage at douglas pouch.
• Operation was finished.