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    EMCASE 6-7-2019 - Edit

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    Komet Rama Daud
    This document summarizes an emergency case report from the surgery department of Wahidin Sudirohusodo General Hospital in Makassar on July 6th, 2019. It describes a 71-year-old male patient who presented with abdominal pain and was found to have generalized peritonitis due to a perforated stomach ulcer. The patient underwent an exploratory laparotomy where a 0.5 cm perforation was discovered and repaired with an omental patch. Post-operatively, the patient's prognosis was doubtful regarding life, healing, and future function due to the severity of the generalized peritonitis.

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    EMCASE 6-7-2019 - Edit

    Uploaded by

    Komet Rama Daud
    13 views23 pages
    This document summarizes an emergency case report from the surgery department of Wahidin Sudirohusodo General Hospital in Makassar on July 6th, 2019. It describes a 71-year-old male patient who presented with abdominal pain and was found to have generalized peritonitis due to a perforated stomach ulcer. The patient underwent an exploratory laparotomy where a 0.5 cm perforation was discovered and repaired with an omental patch. Post-operatively, the patient's prognosis was doubtful regarding life, healing, and future function due to the severity of the generalized peritonitis.

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    EMCASE 6-7-2019- edit

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    This document summarizes an emergency case report from the surgery department of Wahidin Sudirohusodo General Hospital in Makassar on July 6th, 2019. It describes a 71-year-old male patient who presented with abdominal pain and was found to have generalized peritonitis due to a perforated stomach ulcer. The patient underwent an exploratory laparotomy where a 0.5 cm perforation was discovered and repaired with an omental patch. Post-operatively, the patient's prognosis was doubtful regarding life, healing, and future function due to the severity of the generalized peritonitis.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    13 views23 pages

    EMCASE 6-7-2019 - Edit

    Uploaded by

    Komet Rama Daud
    This document summarizes an emergency case report from the surgery department of Wahidin Sudirohusodo General Hospital in Makassar on July 6th, 2019. It describes a 71-year-old male patient who presented with abdominal pain and was found to have generalized peritonitis due to a perforated stomach ulcer. The patient underwent an exploratory laparotomy where a 0.5 cm perforation was discovered and repaired with an omental patch. Post-operatively, the patient's prognosis was doubtful regarding life, healing, and future function due to the severity of the generalized peritonitis.

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    EMERGENCY CASE REPORTS

    Saturday, July 6th 2019


    SURGERY DEPARTMENT

    EMERGENCY ROOM
    Wahidin Sudirohusodo General Hospital
    Makassar
    EMERGENCY CASE REPORT
    Saturday, July 6 th 2019
    Ambulation : 2 Patients
    Hospitalized
    : 5 Patients

    Observation : - Patient
    Operated : 1 Patient
    Death : - Patient
    Total : 7 Patients

    Wahidin Sudirohusodo General Hospital


    Makassar
    Name : Mr. H Age : 71 y.o
    RM : 888208 DPJP : dr. WS

    Chief complain : Abdominal Pain

    History taking : This condition had been suffered since 4 days before hospital admission, and worsened
    since one day before hospital admission. The abdominal pain was felt continuously on
    whole abdomen. There was history of frequent epigastrium pain before. There was no
    history of pain on right lower quadrant. There was history of fever, when the symptom
    was felt at the first time. There was no history of nausea and vomiting. The patient had
    been initially admitted at Enrekang Hospital for 3 days.
    Past medical : There was history of arthritis, treated with NSAID
    history There was history of epigastric pain, treated with antasida
    There was no history of hypertension
    There was no history of chest pain
    There was no history of Diabetes Mellitus

    Micturition : Normal
    Defecation : Last defecation was 3 days ago, There was no changing bowel habit
    General Status
    Karnofsky 60%/poor nourish/conscious

    BW : 45 kg
    Height : 160 cm BMI : 17.6

    Vital Sign
    BP : 90/60 mmHg
    HR : 98 bpm, strong, regular
    RR : 20 x/mnt, symmetric L=R,
    thoracoabdominal type.
    T(Ax) : 37,4°C
    Physical Examination

    Abdomen
    I :Seen convex, bowel contour (-),
    bowel motion (-)
    P :Distended, tenderness(+),
    muscular defense (+)
    P :tapping pain (+), liver dullness
    (-)
    A :Peristaltic sounds decreased
    Rectal Examination
    Anal sphincter tone was loose
    Mucous was smooth
    Rectal ampulla was not collapse
    There was no palpable mass
    Handscoen blood (-), feces (-), slime (-)
    Clinical Diagnosis
    • Generalized Peritonitis due to suspicious hollow viscus
    perforation suspicious gaster perforation
    Boey Score

    Risk score found on patient

    Concomitant severe medical illness -

    Preoperative shock 1

    Duration of perforation >24 h 1

    Total Risk Score 2 (mortality risk 33%)


    Plain Abdominal X-Ray
    Laboratory Result
    HGB : 11.9 gr/dl PT : 10.9
    HCT : 36% INR : 1.05
    WBC : 13.200 aPTT : 34.3
    RBC : 4.36 x 106 GOT : 28
    PLT : 170.000 GPT : 23
    Ureum : 46
    Creatinin : 1.2
    Blood
    : 87
    Glucose
    Albumin : 3.1
    WORKING DIAGNOSIS : Generalized Peritonitis due to hollow viscus perforation
    suspicious gaster perforation

    MANAGEMENT : •Fluid Resuscitation


    •Urine Catheter
    •Antibiotics
    •Plan: Immediate exploratory laparotomy for infection
    source control
    Operation Procedure

    • Patient in supine position under general anesthesia


    • Desinfection and drapping procedure at abdomen
    • Perform midline incision from 5 cm below processus xiphoideus up to 5 cm below
    umbilicus, the incision was deepened sharply until peritoneum was visualized
    • Open peritoneum, approximately 50 cc green – yellowish fluid come out with free
    air, seen adhesion grade 3, performed adhesiolisis
    • Performed exploration and identification hollow viscus started from gaster, seen
    perforation at antrum with 0.5 cm in diameter and gastric juice about 100 cc
    • Refreshed the edge of the wound, and performed omental patch  histopatology
    - Bleeding control, wash the cavum abdomen NaCl 0,9% until clear
    - Close the wound layer by layer with 2 drain left
    - Operation is done
    POST OPERATION : -Generalized peritonitis due to Antrum Gaster
    DIAGNOSIS Perforation

    FOLLOW UP : • Vital Sign


    • Drain
    • Wound healing
    • GCS
    Prognosis :
    Quo ad Vitam Dubia
    Quo ad Sanationan Dubia
    Quo ad Fungtionam Dubia
    THANK YOU

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