Pediatric Surgery Report

Friday, 09 November 2018

Dina/Rhiza/Bunji/Deri/Arsy/Silmi
 Patient Distribution
No Name Sex Age Diagnosis Problem Management Information

1. Kembang F 1,5 Hirschsprung’s associated Respiratory • Vital sign observation Patient in

Nagari yo enterocolitis (Q43.1) + failure • Fasting Kemuning
respiratory failure • NGT decompression no 2nd floor
(J.96.00)+ septic shock 12 fr
(R65.21)+ • Oksigen 10ml, via
hypoalbuminemia endotracheal tube
(E88.09 • Folley catheter no 8 fr
• IVFD TPN 26.3ml/hr,
consist of D10% 550ml,
D40% 50ml, Kcl7.46%
7.5ml, Nacl3% 22.5ml,
• Aminosteril 6% 5.2 ml/ hr
• Vancomysin 3 x 100mg IV
• Metronidazole 3 x 5 mg
IV
• Paracetamol 3 x 150mg
IV
• Albumin transfusion 20%
37.5ml
• Monitor input-output
• Decompression with
rectal tube
• Dobutamine
10mcg/KgBw/mnt
• Dopamine
10mcg/KgBw/mnt
 Patient Distribution
No Name Sex Age Diagnosis Problem Management Information
2. Wira M 1 yo Undescensus testis No • Cefixime syrup 2 x 2ml po Patient in
Ikhsan bilateral palpable (Q53.9) complain • Paracetamol syrup 3 x 7,5 Kemuning 5th
that had been performed ml po floor
bilateral orchidopexy
(62.5) POD 1
3. Moh. M 2 yo Hirschsprung Disease No • Fasting Patient in
Fattarizqi (Q43.1) that had been complain • IVFD TPN 36,1ml/hour Kemuning 2nd
performed Transanal (D10% 683,53 ml, D40% floor
Endorectal Pullthrough 62,14 ml, NaCl 3% 88 ml,
(48.4) + VC (45.2) POD 1 KCl 7,46% 33ml)
• Ceftriaxone 2x550 mg IV
• Metronidazole 3x110 mg
IV
• Paracetamol 4x220 mg IV
• Input and output
monitoring

4. Ardan M Local Peritonitis due to No • IVFD RL 1500 cc/24 hours Patient in

Adransyah appendix perforation complain • Ceftriaxone 2x1 gr IV Kemuning
(K35.3) that had been • Metronidazole 4x400 mg 2nd floor
performed Laparotomy IV
appendectomy (47.0) • Paracetamol 4x400 mg IV
POD 1 • Wound care
1 Patient

OBSERVATION PATIENTS
 Kembang Nagari / F / 1,5 yo (14-02-2017) / BW: 7,5 kg
RM : 0001723309-18025002/Adm : 08-11-2018 / Emergency
Consultant on duty : dr. Emiliana, Sp.BA
The patient has been hospitalized in Kemuning 2 nd floor with diagnose : Hirschsprung’s
associated enterocolitis + respiratory failure + septic shock + hypoalbuminemia
In our duty time :
S : Decreased consciousness, breathing difficulties
O : Consciousness : E1V1Mt. Heart rate : 210 x/m. Respiratory Rate : 40 x/m, temprature : 39°C.
SpO2 90 % endotracheal tube O2 10ml, NGT : 20 cc, brownish
head: conjunctiva not anemic, sclera not ikteric.
chest : symmetrical shape and movement, there was intercostal and suprasternal retraction
pulmo : Vesicular breath sound left = right, no rales
cor : regular sound, no murmur
Abdomen :
I : distended
A : weak bowel sound
P : soft, no edema.
Ekstremitas : warm, CRT < 2 sec
Urine output: 1,8cc/kgBB/jam
 Kembang Nagari / F / 1,5 yo (14-02-2017) / BW: 7,5 kg
RM : 0001723309-18025002/Adm : 08-11-2018 / Emergency
Consultant on duty : dr. Emiliana, Sp.BA
LAB : 09-10-2018:
Hb/Ht/L/Tr: 9,8/31,3/19.130/352.000
PT/INR/APTT: 18/1,68/38,5
Alb: 1,7
SGOT/SGPT : 557/216
Ur/Cr : 57/0,51

A: Hirschsprung’s associated enterocolitis (Q43.1) + respiratory failure (J.96.00)+ septic

shock (R65.21)+ hypoalbuminemia (E88.09)
 Kembang Nagari / F / 1,5 yo (14-02-2017) / BW: 7,5 kg
RM : 0001723309-18025002/Adm : 08-11-2018 / Emergency
Consultant on duty : dr. Emiliana, Sp.BA

P:
• Vital sign observation • Decompression with rectal tube
• Fasting • Monitor input-output
• NGT decompresion no 12 fr • Dobutamine 10mcg/KgBw/mnt
• Oksigen 10ml via endotracheal tube • Dopamine 10mcg/KgBw/mnt
• Folley catheter no 8 fr
• IVFD TPN 26.3ml/hr, consist of D10%
550ml, D40% 50ml, Kcl7.46% 7.5ml,
Nacl3% 22.5ml,
• Aminosteril 6% 5.2 ml/ hr
• Vancomysin 3 x 100mg IV
• Metronidazole 3 x 5 mg IV
• Paracetamol 3 x 150mg IV
• Albumin transfusion 20% 37.5ml
 Observation Table
Time S O A P
09-10-18 Decreased Consciousness : E1V1Mt. Heart rate : Hirschsprung’s • Vital sign observation
15.00 consciousness, 210 x/m. Respiratory Rate : 40 x/m, associated • Fasting
breathing temprature : 39°C. SpO2 90 % enterocolitis + • NGT decompresion no 12 fr
difficulties endotracheal tube O2 10ml, NGT : 20 respiratory failure + • Endotracheal tube O2 10 lpm
cc, brownish septic shock + • Folley catheter no 8 fr
head: conjunctiva not anemic, sclera hypoalbuminemia • IVFD TPN 26.3ml/hr, consist of
not ikteric. D10% 550ml, D40% 50ml,
chest : symmetrical shape and Kcl7.46% 7.5ml, Nacl3% 22.5ml,
movement, there was intercostal and • Aminosteril 6% 5.2 ml/ hr
suprasternal retraction • Vancomysin 3 x 100mg IV
pulmo : Vesicular breath sound left = • Metronidazole 3 x 5 mg IV
right, no rales • Paracetamol 3 x 150mg IV
cor : regular sound, no murmur • Albumin transfusion 20%
Abdomen : 37.5ml
I : distended • Decompression with rectal
A : weak bowel sound tube
P : soft, no edema. • Dobutamine
Ekstremitas : warm, CRT < 2 sec 10mcg/KgBw/mnt
Urine output: 1,8cc/kgBB/jam • Dopamine 10mcg/KgBw/mnt
• Monitor input-output
• GDS : 66
• Informed consent  Decreased
consciousness to the family
• intensive care room still fully
occupied
 Observation Table
Time S O A P
18.00 Decreased Consciousness : E1V1Mt. Heart Hirschsprung’s • Vital sign observation
consciousness, rate : 150 x/m. Respiratory Rate : associated • Endotracheal tube O2 10
breathing 40 x/m, temprature : 37°C. SpO2 enterocolitis + lpm
difficulties 80 % endotracheal tube O2 10ml, respiratory failure • Loading NaCL 0.9%150ml
NGT : 10 cc, brownish + septic shock + (I)
head: conjunctiva not anemic, hypoalbuminemia • IVFD TPN 26.3ml/hr
sclera not ikteric. • Aminosteril 6% 5.2 ml/ hr
chest : symmetrical shape and • Decompression with rectal
movement, there was intercostal tube
and suprasternal retraction • Dobutamine
pulmo : Vesicular breath sound 10mcg/KgBw/mnt
left = right, no rales • Dopamine
cor : regular sound, no murmur 10mcg/KgBw/mnt
Abdomen : • Monitor input-output
I : distended • GDS : 62
A : weak bowel sound
P : soft, no edema.
Ekstremitas : warm, CRT < 2 sec
Urine output: 0,8cc/kgBB/jam
 Observation Table
Time S O A P
19.00 Decreased Consciousness : E1V1Mt. Heart Hirschsprung’s • Vital sign observation
consciousness, rate : 90 x/m. Respiratory Rate : associated • Endotracheal tube O2 10
breathing 40 x/m, temprature : 36.8°C. enterocolitis + lpm
difficulties SpO2 70 % endotracheal tube O2 respiratory failure • Loading NaCL 0.9%150ml
10ml, NGT : 10 cc, brownish + septic shock + (II)
head: conjunctiva not anemic, hypoalbuminemia • IVFD TPN 26.3ml/hr
sclera not ikteric. • Aminosteril 6% 5.2 ml/ hr
chest : symmetrical shape and • Decompression with rectal
movement, there was intercostal tube
and suprasternal retraction • Dobutamine
pulmo : Vesicular breath sound 10mcg/KgBw/mnt
left = right, no rales • Dopamine
cor : regular sound, no murmur 10mcg/KgBw/mnt
Abdomen : • Monitor input-output
I : distended • GDS : 60
A : weak bowel sound
P : soft, no edema.
Ekstremitas : warm, CRT < 2 sec
Urine output: 0,8cc/kgBB/jam
 Observation Table
Time S O A P
19.30 inadequate Consciousness : E1V1Mt. Heart Hirschsprung’s • Vital sign observation
breathing rate : 56 x/m. Respiratory Rate : associated • Endotracheal tube O2 10
40 x/m, temprature : 36°C. SpO2 enterocolitis + lpm
60 % endotracheal tube O2 10ml, respiratory failure • Loading NaCL 0.9%150ml
NGT : - + septic shock + (III)
head: conjunctiva not anemic, hypoalbuminemia • Cardiopulmonary
sclera not ikteric. resuscitation
chest : symmetrical shape and • IVFD TPN 26.3ml/hr
movement, there was intercostal • Aminosteril 6% 5.2 ml/ hr
and suprasternal retraction • Decompression with rectal
pulmo : Vesicular breath sound tube
left = right, no rales • Dobutamine
cor : regular sound, no murmur 10mcg/KgBw/mnt
Abdomen : • Dopamine
I : distended 10mcg/KgBw/mnt
A : weak bowel sound • Monitor input-output
P : soft, no edema. • Informed consent 
Ekstremitas : warm, CRT < 2 sec inadequate breathing to
Urine output : - the family
 Observation Table
Time S O A P
19.40 inadequate Consciousness : E1V1Mt. Heart Hirschsprung’s • Vital sign observation
breathing rate : 52x/m. Respiratory Rate : associated • Endotracheal tube O2 10
40 x/m, temprature : 36°C. SpO2 enterocolitis + lpm
50 % endotracheal tube O2 10ml, respiratory failure • Cardiopulmonary
NGT : - + septic shock + resuscitation
head: conjunctiva not anemic, hypoalbuminemia • IVFD TPN 26.3ml/hr
sclera not ikteric. • Aminosteril 6% 5.2 ml/ hr
chest : symmetrical shape and • Decompression with rectal
movement, there was intercostal tube
and suprasternal retraction • Dobutamine
pulmo : Vesicular breath sound 10mcg/KgBw/mnt
left = right, no rales • Dopamine
cor : regular sound, no murmur 10mcg/KgBw/mnt
Abdomen : • Monitor input-output
I : distended
A : weak bowel sound
P : soft, no edema.
Ekstremitas : warm, CRT < 2 sec
Urine output : -
 Observation Table
Time S O A P
19.50 inadequate Consciousness : E1V1Mt. Heart Hirschsprung’s • Vital sign observation
breathing rate : 22 x/m. Respiratory Rate : associated • Fasting
40 x/m, temprature : 36°C. SpO2 enterocolitis + • NGT decompresion no 12 fr
72 % endotracheal tube O2 10ml, respiratory failure • Endotracheal tube O2 10
NGT : - + septic shock + lpm
Head: conjunctiva not anemic, hypoalbuminemia • Folley catheter no 8 fr
sclera not ikteric. + upper • IVFD TPN 26.3ml/hr
chest : shape and symetric Gastrointestinal • Aminosteril 6% 5.2ml/ hr
movement, there was intercostal bleeding • Dobutamine
and suprasternal retraction 10mcg/KgBw/mnt
pulmo : Vesicular breath sound • Dopamine
left = right, no ronchi 10mcg/KgBw/mnt
cor : regular sound, no murmur • Monitor input-output
Abdomen :
I : flat
A : weak bowel sound
P : soft, no edema.
Ekstremitas : warm, CRT < 2 sec
 Observation Table
Time S O A P
20.00 No impalpable pulse, maximum mydriasis, Light reflexes • Pronouncement
spontaneo -/- of death in front
us of family and
breathing nurse
• COD : Septic
shock
3 Patients

POST-OPERATIVE PATIENTS
 Wira Ikhsan Muharam/M/1 yo (06-08-2017)/BW : 10 kg
MR: 0001680648-/ Adm : 05-11-18/Kemuning 5
Consultant on duty : dr. Kurniawan Oki, SpBA
The patient has been hospitalized in Kemuning 5th floor with working diagnosis :
Undescensus testis bilateral palpable (Q53.9)

Patient underwent Bilateral Orchidopexy (62.5), 09-11-2018 by dr. Nurul

Intraoperative findings :
• Right testis was found in distal inguinal canal, size 1x1xx0,5 cm and can be pulled
down to mid scrotum.
• Left testis was found in mid inguinal canal, size 1x0,5x0,5 cm and can be pulled
down to upper part of the scrotum.
Wira Ikhsan Muharam/M/1 yo (06-08-2017)/BW : 10 kg
Bilateral Orchidopexy (62.5)
09-11-2018, operator: dr. Nurul
Wira Ikhsan Muharam/M/1 yo (06-08-2017)/BW : 10 kg
Bilateral Orchidopexy (62.5)
09-11-2018, operator: dr. Nurul
 Wira Ikhsan Muharam/M/1 yo (06-08-2017)/BW : 10 kg
MR: 0001680648-/ Adm : 05-11-18/Kemuning 5
Consultant on duty : dr. Kurniawan Oki, SpBA

In our duty time (15 hours post operation)

S : no complain

O : consciousness = compos mentis, heartrate: 94 x/minutes, respiration : 24

x/minutes, temp : 36,7℃, VAS = 1
Abdomen : flat, soft, normal bowel sound
Operation wound : no active bleeding
Extremities : warm, CRT < 2”
 Wira Ikhsan Muharam/M/1 yo (06-08-2017)/BW : 10 kg
MR: 0001680648-/ Adm : 05-11-18/Kemuning 5
Consultant on duty : dr. Kurniawan Oki, SpBA

A : Undescensus testis bilateral palpable (Q53.9) that had been performed bilateral
orchidopexy (62.5) POD 1

Post-Operation instruction : P:
• Cefixime syrup 2 x 2ml po • Solid diet
• Paracetamol syrup 3 x 7,5 ml po
 Moh Fattarizqi/ M / 2 yo (12-06-2016) /BW : 11 kg
Anamnesis
MR : 0001550226-18024981/ ADM : 07-11-2018/Kemuning 2
Consultant on duty : Dr. Rizki, dr., SpBA (K)
The patient has been hospitalized in Kemuning 2nd floor with working diagnosis :
Hirschsprung’s Disease (Q43.1)

Patient underwent Transanal Endorectal Pullthrough (48.4) + Frozen Section (45.2),

09-11-18, operator dr. Eva

Intraoperative findings :
• Found spastic zone with ± 6 cm in length, transitional zone with 3 cm in length and
dilatation zone in sigmoid colon
• Frozen section result : there was adequate of ganglion
 Moh Fattarizqi/ M / 2 yo (12-06-2016) /11 kg
Transanal Endorectal Pullthrough (48.4) + VC (45.2)
09-11-18, Operator : dr. Eva
 Moh Fattarizqi/ M / 2 yo (12-06-2016) /BW : 11 kg
MR : 0001550226-18024981/ ADM : 07-11-2018/Kemuning 2
Consultant on duty : Dr. Rizki, dr., SpBA (K)
In our care hour (15 hours post operation)

S : no complain

O : consciousness = compos mentis, heartrate: 90 x/minutes, respiration : 22

x/minutes, temp : 36,6℃, VAS = 1

Abdomen : flat, soft, normal bowel sound

Anus : no active bleeding
Extremities : warm, CRT < 2”
 Moh Fattarizqi/ M / 2 yo(12-06-2016) /11 kg
MR : 0001550226-18024981/ ADM : 07-11-2018
Consultant on duty : Dr. Rizki, dr., SpBA (K)
A : Hirschsprung Disease (Q43.1) that had been performed Transanal Endorectal
Pullthrough (48.4) + VC (45.2) POD 1

Instruksi post operasi : P:

• Fasting • Retaining rectal tube until POD 3
• IVFD TPN 36,1ml/hour (D10% 683,53
ml, D40% 62,14 ml, NaCl 3% 88 ml, KCl
7,46% 33ml)
• Ceftriaxone 2x550 mg IV
• Metronidazole 3x110 mg IV
• Paracetamol 4x220 mg IV
• Input and output monitoring
 Ardan Adransyah / M / 9 yo (03-12-2008) / BW: 20 kg
RM : 0001723371 - 18025005 / Adm : 08-11-2018 / Emergency
Consultant on duty : dr. Bustanul Arifin SpBA(K)
The patient has been hospitalized in Emergency room with working diagnosis : Local
Peritonitis due to appendix perforation (K35.3)

Patient underwent Laparotomy appendectomy (47.0), 09-11-18, operator dr. Utami

Intraoperative findings :
• Localized pus were found in right lower abdomen ± 50 cc
• Appendix was located on antecaecal, with 5,5 cm in length, 1 cm in diameter,
edematous, hyperemic, perforation on third middle of appendix, fecalith was
found extra luminal.
 Ardan Adransyah / M / 9 tahun
Laparotomy Appendectomy (47.0)
09-11-18, Operator : dr. Utami
 Ardan Adransyah / M / 9 tahun
Laparotomy Appendectomy (47.0)
09-11-18, Operator : dr. Utami
 Ardan Adransyah / M / 9 tahun
Laparotomy Appendectomy (47.0)
09-11-18, Operator : dr. Utami
 Ardan Adransyah / M / 9 yo (03-12-2008) / BW: 20 kg
RM : 0001723371 - 18025005 / Adm : 08-11-2018 /Emergency
Consultant on duty : dr. Bustanul Arifin SpBA(K)
In our care hour (14 hours post operation)

S : no complain

O : consciousness = compos mentis, heartrate: 96 x/minutes, respiration : 20

x/minutes, temp : 37,2℃, VAS = 1

Abdomen : flat, soft, normal bowel sound

Operation wound : no active bleeding
Extremities : warm, CRT < 2”
 Ardan Adransyah / M / 9 yo (03-12-2008) / BW: 20 kg
RM : 0001723371 - 18025005 / Adm : 08-11-2018 / Emergency
Consultant on duty : dr. Bustanul Arifin SpBA(K)
A : Local Peritonitis due to appendix perforation (K35.3) that had been performed
Laparotomy appendectomy (47.0) POD 1

Instruksi post operasi : P:

• IVFD RL 1500 cc/24 hours • Feeding test  solid diet
• Ceftriaxone 2x1 gr IV
• Metronidazole 3x200 mg IV
• Paracetamol 4x400 mg IV
• Wound care
TERIMA KASIH