DUTY REPORTTuesday, March 24th, 2015

RESIDENT: Amrul Mukminin

Consultants in Charge

• Pediatric surgery : dr. Yessi Eldiani, Sp.BA• Digestive surgery : dr. A Hamid R, Sp.B(K)BD• Orthopedic surgery : dr. Muljana H, Sp.OT• Plastic surgery : dr. Guntoro, Sp.BP• Neuro surgery : dr. Agus Yunianto, Sp.BS• Oncology surgery : dr. Taslim M, Sp.B.Onk• Thoraco surgery : dr. Arief W, Sp.BTKV• Urology surgery : dr. Hani A, Sp.U

Patients’ resume

Outpatient : 2 patientsOperation : 1 patientHospitalized : 0 patient

Operation

Identification :Name : Mr.SAge : 53 y.oGender : Male

History of Present Illness

• Chief Complaint : Lump on left scrotum since 3 days prior to the admission

• 3 days prior admission to the emergency ward, the patient felt lump on his left scrotum after he had a bad cough. He was unable to push upward the bulge. There was pain.The pain was increased . No vomit and the patient wasn’t able to defecate since one day before admission and fart normally. No Fever. The patient can urinate normally

• Since 10 years before, patient had already experienced lump on his left groin everytime he lifts heavy materials

History of Past illness

• No Diabetes mellitus• No Hipertention

Physical Examination

• Consciousness : Alert• BP : 130/80 mm HG• PR : 92 x/mnt• RR : 20x/mnt• T : 36.8 C

Physical Examination• Head : Normocephal• Eyes : No pale conjungtiva, no icteric sclera• ThoraxI : Symetrical bilaterally on inspiration and expirationP: vocal fremtus +/+P : sonor +/+A : Lung sound was vesiculair +/+, rales -/-, wheezing -/- heart sound was normal, no gallop ,no murmur

Physical Examination

• Abdomen : I : flat, no bowel contour, no bowel movementsP : supple, pain,muscular rigidity (-)P : tympanyA : Bowel sound was normal

Local Status

Left Scrotal regionI : lump on left inguinal and left scrotum,

Hyperemic on the scrotum, P : Tenderness +, Tension +, Temperatur was the

same as the surrounding part, Testicle +/+ normal.

Laboratorium Findings

• Hb: 15,1g/dl• Ht : 44 %• Leucocyte : 9880/ul• Thrombocyte:

262000/ul• Random Blood Sugar

: 140 mg/dl

• Ureum : 43• Creatinine : 1.2• Na/K/Cl :

144/3.5/105

Clinical Pictures

Diagnose

• Right scrotal strangulated hernia

Plan

• Herniotomy and Hernioraphy cito • Rehydration• Antibiotics• Analgesic s

Operative finding

- When the hernia sac wan open, 20 cc serous fluid was camed out.

- The hernia sac contains one loop ileum (40 cm),peristaltic (+),tongs boundary was not clear. Conclusion was vital ileum.

- Ileum was inserted into abdominal cavity. Distal and proximal hernia sac were separated.

• Mesh was applied and sutured in conjoint tendon,inguinal ligament and tuberculum pubicum.

Operative finding

• Thank You