CASE IV

Female, 17 years old, came to hospital with

chief complain: abdomen distended
History : It had been suffering since 4 days before
admitted to the hospital.
There are nausea and vomiting.
No defecation since 4 days ago but the patient still
flatus. No flatus since 1 day ago.
She had history of laparatomy due to generalized
peritonitis cause of appendicitis perforation 10 days
ago in another hospital.
Micturation : normal
General Status
Moderate illness / unadequate nutrition / conscious

Vital Sign
BP : 120/80 mmHg
PR : 80 x/mnt, strong and reguler
RR : 20 x/mnt, symetric, thoracoabdominal type
T(Ax) : 36,8°C
Local Status

Abdominal
I : Convex, synchronized with the
respiratory
movement, skin color same with its
vicinity,
no darm countur.
There was stitched wound at midline
P : No tumor mass, no defance muscular,

no tenderness,
Digital Rectal Examination :

Sphincter tone was tight

Mucosa was smooth
Ampulla collapse
No tumor mass
Gloves: faces (+), blood (-), slime (-)
 Laboratory Findings
 WBC : 8.69 x 103 /uL
 RBC : 4.55 x 106/uL
 HGB : 12,7 gr/dL
 HCT : 43.7%
 PLT : 276 x 103 /uL
 CT : 7’00”
 BT : 2’30”
 Blood sugar : 68 mg/dl
 Ureum : 35.0 mg/dl
 Creatinin : 0.65 mg/dl
 SGOT/SGPT : 53/41 U/I
 Preoperation Diagnosis

Ileus Obstruction cause of suspicious Adhesive

 MANAGEMENT

- IV-line for resuscitation

- Apply NGT
- Urine Catheter
- Antibiotics
- AH2 receptor
- Exploration Laparatomy
 OPERATION PROCEDURE
- Patient lied in supine position, under GA
- Sterile and draping procedure
- Incised midline on the previous laparatomy site, deepen
until peritoneum
- Open the peritoneum, found massive adhesion, found
part of intestines dilatated and the others collapsed
- Released adhesion gently and perform exploration
hollow viscous until found adhesive band between
ileum to ileum, ileum to caecum, caecum to peritoneum
parietal, colon descenden banded and distal part
collapse located at 20 cm from ileocaecal valve
(Bauhini).
- Perform milking to evaluate air passes to distal
- Rinse peritoneum cavity with warm normal saline until
clean and continued rinse with dextran L
- Closed operative wound
Incised midline on the previous laparatomy site
Deepen until peritoneum
Open the peritoneum
Found massive adhesion, found part of intestines dilatated
and the others collapsed
Released adhesion gently and perform exploration hollow viscous
until found adhesive band between ileum-ileum, ileum-caecum,
caecum–peritoneum parietal, colon descenden banded and distal
part collapse located at 20 cm from ileocaecal valve (Bauhini).
Perform milking to evaluate air passes to distal
Rinse peritoneum cavity with warm normal saline until clean
and continued rinse with dextran L
After complete release, prepared to close operation wound
Closed operative wound
 Postoperation Diagnosis

Ileus obstruction due to Adhesive Band