CASE PRESENTATION RIGHT LATERAL INGUINAL IRREPONIBLE HERNIA BY: DITA EKA SARTIKA DOSSON RIANTO PUTU RATIH

LAMBOK YOHANNA

COUNSELOR: EDUARD P SIMAMORA, DR., SPB, SPBA

D E PA R T E M E N T O F S U R G E R Y M E D I C A L FA C U LT Y M A R A N AT H A C H R I S T I A N UNIVERSITY I M M A N U E L H O S P I TA L BANDUNG

2013

PATIENTS IDENTITY NAME : N.R AGE : 7 YEARS SEX : MALE RELIGION : MOSLEM NATIONALITY : INDONESIAN ADMISSION DATE AND TIME : JAN 28TH, 09:00 WIB EXAMINATION DATE AND TIME JAN 28TH, 09:00 WIB

PRESENT MEDICAL STATUS

History of Present Illness History was taken by Autoanamnesis from patient himself as informant on : Jan 28th, 09:00 WIB Patient came because right scrotum enlargment Since 3 years before admission the patient was complaining that his scrotum was enlarge. The enlargement usually happen in the morning while the patient doing activities. But in the night the enlargement is lost. Patient does not have any complain about mixing. Patient was born in 38 weeks gravid and came with BW 3.250 gr Family medical history : None of the family member had experienced symptoms like patient Allergic History : There is no allergic history

GENERAL APPEARANCE : MILD CONSCIOUSNESS : COMPOS MENTIS PULSE : 120 X/MINUTE, REGULAR, STRONG, EQUAL RESPIRATION : 28 X/MINUTE, NORMAL PATTERN TEMPERATURE : 36,5 C WEIGHT : 25 KG HEIGHT : 120 CM NUTRITIONAL STATUS : GOOD SKIN : ANEMIC (-), ICTERIC (-), NORMAL TURGOR EYES : ANEMIC CONJUNCTIVA -/-, ICTERIC SCLERA /-, PUPIL ROUND, ISOKOR 3 MM, LIGHT REFLEX +/+ REACTIVE NOSE :NECK : NO LYMPH NODE ENLARGEMENT, MASS (-) CHEST : SHAPE AND MOVEMENT SIMETRIC IN BOTH SIDES. COR: NORMAL HEART SOUND, REGULAR, SHUFFLE (-) PULMO : VBS +/+, RALES (-), WHEEZING (-)

ABDOMEN : INSPECTION : SCAPHOID PALPATION : TENDER (-), DISTENTION (-), MASS(-), DEFENCE MUSCULAR (-). PERCUSSION : TYMPANIC AUSCULTATION : NORMAL BOWEL SOUND ANUS-RECTUM : NORMAL INGUINAL AND GENITAL : NORMAL

EXTREMITIES

: EDEMA (-)

NEUROLOGY : NO NEUROLOGICAL DEFICITS AND NORMAL REFLEXES

DIAGNOSE
PRE-OPERATIVE DIAGNOSIS :HIDROCELE POST-OPERATIVE DIAGNOSIS : RIGHT LATERAL INGUINAL IRREPONIBLE HERNIA

SURGICAL THERAPY

Herniotomy During Operation found: Omentum inside Hernias pouch

MEDICAMENTOSA THERAPY

CESPAN 2X50 MG TRAMIPEN 3X1

PROGNOSIS
Quo ad vitam Quo ad functionam : ad bonam : ad bonam

A BOY 7TH YEARS OLD , MILD ILL, COMPOS MENTIS, , WAS ADMITTED TO IMMANUEL HOSPITAL ON JAN 28TH, 2013, WITH CHIEF COMPLAIN RIGHT SCROTUM ENLARGEMENT. SINCE 3 YEARS BEFORE ADMISSION THE PATIENT WAS COMPLAINING THAT HIS SCROTUM WAS ENLARGE. THE ENLARGEMENT USUALLY HAPPEN IN THE MORNING WHILE THE PATIENT DOING ACTIVITIES. BUT IN THE NIGHT THE ENLARGEMENT IS LOST. PATIENT DOES NOT HAVE ANY COMPLAIN ABOUT MIXING , SO DOES DEFECATION. PATIENT WAS BORN IN 38 WEEKS GRAVID AND CAME WITH BW 3.250 GR

PHYSICAL EXAMINATION
General Appearance : Mild Consciousness : Compos Mentis Pulse : 120 x/minute, regular, strong, equal Respiration : 20 x/minute, normal pattern Temperature : 36,5 0C Weigh : 25 kg Height : 120 cm Nutritional Status : good Shape and Movement simetric in both sides. Cor: Normal heart sound, regular, shuffle (-) Pulmo : VBS +/+, rales (-), wheezing (-) a/r Abdomen : Inspection : scaphoid Palpation : tender (-), distention (-), mass (-), defence muscular (-). Percussion : tympanic Auscultation : normal bowel sound

DIAGNOSE
PRE-OPERATIVE DIAGNOSIS : HIDROCELE POST-OPERATIVE DIAGNOSIS : RIGHT LATERAL INGUINAL IRREPONIBLE HERNIA

SURGICAL THERAPY

Herniotomy During Operation found: Omentum inside Hernias pouch

MEDICAMENTOSA THERAPY

CESPAN 2X50 MG TRAMIPEN 3X1

PROGNOSIS
Quo ad vitam Quo ad functionam : ad bonam : ad bonam

DISCUSSION
This patient have diagnosed right laterale inguinal irreponible hernia, based on : From Autoanamnesis : Patient complain, since 3 years ago, he had his srotum enlarged. The enlargement usually happen in the morning while the patient doing activities. But in the night the enlargement is lost. . Patient was born in 38 weeks gravid and came with BW 3.250 gr Pain(-), fever (-) Genitalia Inspection : There is right scrotum enlargement ( asymetric scrotum ) Palpation : , testis size are simetris, consistency solid

At first time , patient was diagnosed hidrocele, but after surgery, there was omentum founded in hernia pouch.
In a child, they are essentially the same thing. Hydrocele refers to fluid in the scrotum or inguinal canal where a hernia often refers to the intestine or other abdominal contents. Fluid may have come through the canal before it closed off and then became trapped in the scrotum (noncommunicating hydrocele) If the tract remains open then the fluid may go back and forth between the scrotum and abdomen (communicating hydrocele). You will notice the size of the scrotum change throughout the day, often getting larger when the child cries or has a bowel movement.

HYDROCELE
Accumulation of liquid in the scrotum between the visceral and parietal areas of the tunica vaginalis that in infants is usually the result of incomplete closure of the processus vaginalis. It may or may not be associated with inguinal hernia. In older boys and men it may be idiopathic but more likely to be secondary to another pathologic process in the scrotum or adjacent structures How is a hydrocele diagnosed? A hydrocele is usually diagnosed by an examination of the scrotum, which may appear enlarged. As part of the examination, doctor will shine a light behind each testicle (transillumination). This is to check for solid masses that may be caused by other problems, such as cancer of the testicle. Hydroceles are filled with fluid, so light will shine through them (transillumination)

Hydrocele usually happen to child who was born premature

WHAT IS AN INGUINAL HERNIA?

Inguinal Hernia As a male fetus grows and matures during pregnancy, the testicles develop in the abdomen and then move down into the scrotum through an area called the inguinal canal. Shortly after the baby is born, the inguinal canal closes, preventing the testicles from moving back into the abdomen. If this area does not close off completely, a loop of intestine can move into the inguinal canal through the weakened area of the lower abdominal wall, causing a hernia

 If the hernia is not reducible, then the loop of intestine may be caught in the weakened area of abdominal muscle. Symptoms that may be seen when this happens include the following: a full, round abdomen vomiting pain or fussiness redness or discoloration fever

AN OPERATION IS NECESSARY TO TREAT AN INGUINAL HERNIA. IT WILL BE SURGICALLY REPAIRED FAIRLY SOON AFTER IT IS DISCOVERED, SINCE THE INTESTINE CAN BECOME STUCK IN THE INGUINAL CANAL. WHEN THIS HAPPENS, THE BLOOD SUPPLY TO THE INTESTINE CAN BE CUT OFF, AND THE INTESTINE CAN BECOME DAMAGED. INGUINAL HERNIA SURGERY IS USUALLY PERFORMED BEFORE THIS DAMAGE CAN OCCUR.