Morning Report

Sunday, August 27th 2017

Team on duty
dr. AA Ahmad Dimyanti (Chief)
dr. Tommy Rivelino (Chief)
dr. Raja Raharja Marlunglung purba (Jaga 1)
dr. Aswad Affandi (Jaga 1)
dr. Andri Feisal Nasution (Jaga 2)
dr. Kas Mulyadi (Jaga 2)
dr. Andrian (Jaga 3)
dr. Ahmad Mutadi (Jaga 3)
dr. Syahmardani Ibnu (Jaga 4)
dr. San Winata Badiri (Jaga 4)
dr. Muhammad Arafat Muchtar (Jaga 5)
dr. T. Fenny Nohera (Jaga 5)
dr. Idham Adyasa Manggala Putra (Jaga 6)
dr. Mayenru Dwindra (Jaga 6)

• Patient identity
• Name : Birrul Walidain
• Age : 2 months old
• Sex : Boy
• Address : Blang Puuk Nigan Seunangan, Nagan Raya
• Body weight : 5,1 kgs
• CM : 1140413
• Father’s phone : 085210257219
• Admisssion Time : 24.57 WIB

Chief complaint
Abdominal distension
Patient illnes History
• The patient was referred from Meulaboh distric hospital to Zainoel Abidin Emergency Room
with a chief complaint abdominal distension since 3 days ago.
• According to the mother, since 3 days ago the baby can’t defecation and his abdomen
became distension.
• History of greenish vomiting (+)
• There was history of colicky pain
Physical examination
• Suckling Reflex : weakness
• Grasping Reflex : weakness
• Crying : weakness
• General appearance : Moderate
• Pulse : 140 beats / min
• Respiratory rates : 36 breaths/min
• Body temperature : 36,5 oC
L/S at abdominal region
• I : Distension, visible peristaltic (+).
• A : Bowel sound increase
• P : Musculaire rigidity (-), dance sign (+), Sausage like mass sign (+)
• P : Tymphani (+)

Digital Rectal Examination :

• Tonus Sphincter ani was tight
• Recti Ampulla was empty
• Recti mucose smooth
• Glove : currant jelly stool (+)

Assessments:
Abdominal distension due to
dd : 1. suspect intussusception
2. midgut volvulus

Management
• Stop Oral Intake
• IVFD 4:1 500 cc/24 hours
• Urinary Catheter : initial urine  10 cc
• NGT Decompression
• Inj. Ceftriaxone 250 mg
• Inj. Metamizole sodium 50 mg
• Laboratory examination
• Radiology examination

Laboratory result
• Hb : 7,5 g/dl  transfusion
• White blood count : 10.500/ul
• Platelet : 277.000/ul
• Ht : 22 %
• CT : 7 minute
• BT : 2 minute
• Glucose ad random : 86 mg/dL
• Sodium : 138 meq/L
• Potassium : 4.4 meq/L
• Chloride : 96 meq/L
 Hour Urine
01.00 8 cc

02.00 7 cc

03.00 8 cc

04.00 8 cc

05.00 10 cc

06.00 8 cc

07.00 7 cc

08.00 8 cc

09.00 8 cc

10.00 7 cc

11.00 8 cc

12.00 7 cc

13.00 8 cc

14.00 8 cc

Radiology Result :
Baby Gram
• Air distribution not until distal colon
• Dilatation of bowel
USG
• Pseudokidney sign (-)
• Target sign (-)
• Corkscrew (+)

Diagnose :
• Abdominal distension due to
dd : 1. suspect intussusception
2. midgut volvulus
• Anemia

Consult to pediatric surgery division :

• Laparotomy exploration emergency
• Intra operative
• Patient was supine position with general anesthesia.
• Aseptic and antiseptic procedure.
• Perfomed supraumbilical transverse incision deeper until peritonium
• Peritonium is opened
• Performed exploration from treitz ligament until distal
• Found volvulus ± 20 cm from ICJ, blackness with size ± 20 cm
• Ileum resection ± 20 cm from ICJ to the proximal, and performed ileostomy end stoma
• Performed appendectomy
• Abdominal cavity was rinse with normal saline until clean
• Wound operation closed by primary sutured
Post operative diagnosed
1. Volvulus at the Ileum terminal ( ICD 10 CM K562)
2. Anemia ( ICD 10 CM D64.9)