Case Iv

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 RBC HGB HCT PLT CT BT Blood sugar Ureum Creatinin SGOT/SGPT

: : : : : : : : :

8.69 x 103 /uL 4.55 x 106/uL 12,7 gr/dL 43.7% 276 x 103 /uL 7’00” 2’30” 68 mg/dl 35.0 mg/dl : 0.65 mg/dl : 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