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    eEMCASE - MAR Letak Rendah Tanpa Fistel

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    ashy
    This document contains an emergency case report from a hospital in Makassar, Indonesia. It describes the case of a 2-day-old baby born with no anal canal who was referred from another hospital. The report includes details of the physical exam, lab results, x-rays, diagnosis of anorectal malformation without fistula or dehydration, and management plan of IV fluids, feeding tube, catheter, and limited PSARP surgery. Post-op diagnosis and prognosis are also noted.

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    eEMCASE - MAR Letak Rendah Tanpa Fistel

    Uploaded by

    ashy
    31 views22 pages
    This document contains an emergency case report from a hospital in Makassar, Indonesia. It describes the case of a 2-day-old baby born with no anal canal who was referred from another hospital. The report includes details of the physical exam, lab results, x-rays, diagnosis of anorectal malformation without fistula or dehydration, and management plan of IV fluids, feeding tube, catheter, and limited PSARP surgery. Post-op diagnosis and prognosis are also noted.

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    eEMCASE - MAR letak rendah tanpa fistel.pptx

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    This document contains an emergency case report from a hospital in Makassar, Indonesia. It describes the case of a 2-day-old baby born with no anal canal who was referred from another hospital. The report includes details of the physical exam, lab results, x-rays, diagnosis of anorectal malformation without fistula or dehydration, and management plan of IV fluids, feeding tube, catheter, and limited PSARP surgery. Post-op diagnosis and prognosis are also noted.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    31 views22 pages

    eEMCASE - MAR Letak Rendah Tanpa Fistel

    Uploaded by

    ashy
    This document contains an emergency case report from a hospital in Makassar, Indonesia. It describes the case of a 2-day-old baby born with no anal canal who was referred from another hospital. The report includes details of the physical exam, lab results, x-rays, diagnosis of anorectal malformation without fistula or dehydration, and management plan of IV fluids, feeding tube, catheter, and limited PSARP surgery. Post-op diagnosis and prognosis are also noted.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 22

    EMERGENCY CASE REPORTS

    Wednesday, August 26th 2020


    SURGERY DEPARTMENT

    EMERGENCY ROOM
    Wahidin Sudirohusodo General Hospital
    Makassar
    Name : Ch. EE Age : 2 days
    RM : 893594 DPJP : dr. UM
    BW : 3600gr

    CHIEF COMPLAIN : No Anal Canal


    HISTORY TAKING : This condition has been present since the baby was born. There wasn’t history
    of vomiting, fever and seizure. There wasn”t history of dyspnea or cyanosis
    when the baby crying. There wasn’t history of same disorder in the family.
    History of maternal pregnancy : the patient was born normal pervaginam
    assisted by midwife with gestational age 39 weeks, birth weight 3600 grams
    and APGAR score 8/9. During pregnancy the mother controls the ANC
    routinely at the doctor PKM, there wasn’t history of ultrasound check. There
    was no history of drugs or herbs consumed during pregnancy. The patient was
    referred from RSUD Majene.

    MICTURATION : Via urethra, 0,5cc/KgBB/Hours, yellow, no feces


    DEFECATION : No anal canal
    PHYSICAL EXAMINATION
    GENERAL STATUS:
    Active / well-nourished / compos mentis / BW 3600 grams

    VITAL SIGN:
    HR: 136x/min RR: 30x/min T(Ax): 36.8°C

    HEAD & FACE:


    Conjunctiva anemic (-), sclera icteric (-), large fontanel drops (-), dry lips
    and mouth mucosa (-), perioral cyanosis (-), hypersalivasi (-)

    THORAX :
    Symmetric
    Lungs : Equal Bronchovesikuler Breath Sound , Ronchi :-/-, Wheezing: -/-
    Heart : Regular Heart Sound , Murmur : -
    PHYSICAL EXAMINATION
    ABDOMEN
    I : convex, distended, follow breath motion, skin color was the
    same with its vicinity, darm contour (-), darm steifung (-)
    A : peristaltic sound was increased
    P : Soefel (+)
    P : tympani
    PHYSICAL EXAMINATION
    Anal Region
    I : Anal canal (-)
    Bucket handle (-)
    Anal dimple (+)
    Fistule (-)

    Genital Region
    Seen OUE in the distal of penis
    Meconium (-)
    DEHYDRATION STATUS

    • Head Fontanel: normal


    • Eye: normal
    • Lip/Mouth: moist
    • Turgor: normal
    CLINICAL DIAGNOSIS

    Anorectal Malformation With No Fistula


    Without Dehidration
    LABORATORY RESULT
    WBC : 10,1 x 103 /μL Natrium : 144 mmol/L

    RBC : 4,58 x 106 /μL Kalium : 3,4 mmol/L

    HGB : 15,6 g/dL Chlorida : 105 mmol/L

    HCT : 52 % SGOT : 61 U/L

    PLT : 160 x103/ µl SGPT : 15 U/L

    PT/ aPTT : 33,7 s / 46,1 s IgM & IgG : Non Reactive

    INR : 3,69

    Blood Sugar : 75 mg/dl

    Ureum : 33mg/dl

    Creatinin : 1,30 mg/dl


    CROSS TABLE LATERAL KNEE-CHEST POSISI X-RAY
    BABY GRAM
    WORKING : - Low Level Anorectal Malformation With No
    DIAGNOSIS Fistula
    -Without Dehidration
    -Lengthening of The Hemostasis Function

    MANAGEMENT : • IVFD Asering


    • (Maintenance 3,6 x 100 = 360cc/24 hours)
    • Insert OGT
    • Insert Urinary catheter
    • Consult to NICU
    (Infant warmer care, stop intake oral, parenteral
    nutrition, antibiotik, Inj Vit. K 1mg/IM)
    • Plan for Limited PSARP (Anoplasty)
    THANK YOU
    USG PERINEUM
    WHO Dehydration Classification
    ANATOMI

    • Oldham K, Colombani P, Foglia R, Skinner M. Rektum and Anus. In: Principles and Practice of Pediatric Surgery Vol.2. Philadelphia: Lippincott Williams & Wilkins, 2005;
    p.1395-1434
    https://www.grepmed.com/images/1
    710/association-pediatrics-diagnosis-
    anomalies-vacterl-peds
    KLASIFIKASI
    Penggolongan Anatomi Malformasi Anorektal menurut Sjamsuhidayat (Laki-laki)

    Golongan I : Tindakan :
    1.Fistel urine Kolostomi neonatus pada usia
    2.Atresia rekti 4-6 bulan
    3.Perineum datar
    4.Tanpa fistel udara> 1cm dari kulit pada
    invertogram

    Golongan II : Tindakan :
    1.Fistel perineum Operasi definitif neonatus
    2.Membran anal tanpa kolonostomi
    3.Stenosis ani  
    4.Bucket handle  
    5.Tanpa fistel, udara < 1 cm dari kulit pada  
    invertogram

    • Oldham K, Colombani P, Foglia R, Skinner M. Rektum and Anus. In: Principles and Practice of Pediatric Surgery Vol.2. Philadelphia: Lippincott Williams & Wilkins, 2005;
    p.1395-1434
    PSARP
    PSARP dibagi menjadi tiga yaitu minimal, limited, dan full PSARP

    MINIMAL LIMITED

    Minimal PSARP tidak Limited PSARP yang FULL


    dilakukan pemotingan dibelah adalah otot
    otot levator maupun sfingter eksternus, Full PSARP dilakukan
    vertical fibre, yang muscle fibre, muscle pada atresia ani letak
    penting adalah complex, serta tidak tinggi, pada fistel
    memisahkan common memotong levator. rektovaginalis, fistel
    wall untuk Dan dilakukan pada rekto uretralis, atresia
    memsahkan rektum atresia ani dengan rektum, bladder neck
    dengan vagina dan fistel rektovestibular dan stenosis rektum
    dibelah hanya otot
    sfingter eksternus
    perineal
    • Van der steeg, H. J. J., et al. European consensus meeting of ARM-Net members concerning diagnosis and early management of newborns with anorektal
    malformations. Techniques in coloproctology, 2015, 19.3: 181-185.
    • Bischoff, A., Bealer, J., & Peña, A. (2017). Controversies in anorektal malformations. The Lancet Child & Adolescent Health, 1(4), 323-330.
    TEKNIK OPERASI
    Dilakukan dengan general anestesi,
    Stimulasi perineum dengan alat
    dengan intubasi endotrakeal,
    Pena Muscle Stimulator untuk
    dengan posisi pasien tengkurap dan
    identifikasi anal dimple.
    pelvis ditinggikan.

    Dibelah jaringan subkutis, lemak, Insisi bagian tengah sakrum kearah


    parasagital fiber dan muscle bawah melewati pusat spingter dan
    complex. berhenti 2 cm didepannya

    Os koksigeus dibelah sampai tampak


    muskulus levator, dan muskulus Rektum dibebas dari jaringan
    levator dibelah tampak dinding sekitarnya
    belakang rektum

    Rektum ditarik melewati levator,


    Dilakukan anoplasti dan dijaga
    muscle complex dan parasagital
    jangan sampai tension.
    fiber.

    • Bischoff A, Dickie BH, Levitt MA, Peña A. Anorektal Malformations. Pediatric Surgery. 2017:1-27.
    POST OP DIAGNOSIS : - Low Level Anorectal Malformation With
    No Fistula
    - Without Dehidration

    FOLLOW UP : • Vital sign


    • Wound care

    PROGNOSIS : Good

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