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    Mekong Hernia 30 Oktober 2021

    Uploaded by

    Yolanda Rahayu
    This patient is a 71-year-old male who presented with an inability to defecate for 3 days and a 1-year history of a lump in his right groin that appears with straining. On examination, a 10x8x5 cm mass was found on his left scrotum. Chest x-ray and laboratory tests were performed. A working diagnosis of left incarcerated inguinal hernia with suspected COVID-19 was made. The patient underwent an emergency left herniorrhaphy under spinal anesthesia. During surgery, small bowel and caecum were found in the hernia sac. The sac was repaired with a mesh and the wound closed in layers.

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    Mekong Hernia 30 Oktober 2021

    Uploaded by

    Yolanda Rahayu
    35 views15 pages
    This patient is a 71-year-old male who presented with an inability to defecate for 3 days and a 1-year history of a lump in his right groin that appears with straining. On examination, a 10x8x5 cm mass was found on his left scrotum. Chest x-ray and laboratory tests were performed. A working diagnosis of left incarcerated inguinal hernia with suspected COVID-19 was made. The patient underwent an emergency left herniorrhaphy under spinal anesthesia. During surgery, small bowel and caecum were found in the hernia sac. The sac was repaired with a mesh and the wound closed in layers.

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    This patient is a 71-year-old male who presented with an inability to defecate for 3 days and a 1-year history of a lump in his right groin that appears with straining. On examination, a 10x8x5 cm mass was found on his left scrotum. Chest x-ray and laboratory tests were performed. A working diagnosis of left incarcerated inguinal hernia with suspected COVID-19 was made. The patient underwent an emergency left herniorrhaphy under spinal anesthesia. During surgery, small bowel and caecum were found in the hernia sac. The sac was repaired with a mesh and the wound closed in layers.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    35 views15 pages

    Mekong Hernia 30 Oktober 2021

    Uploaded by

    Yolanda Rahayu
    This patient is a 71-year-old male who presented with an inability to defecate for 3 days and a 1-year history of a lump in his right groin that appears with straining. On examination, a 10x8x5 cm mass was found on his left scrotum. Chest x-ray and laboratory tests were performed. A working diagnosis of left incarcerated inguinal hernia with suspected COVID-19 was made. The patient underwent an emergency left herniorrhaphy under spinal anesthesia. During surgery, small bowel and caecum were found in the hernia sac. The sac was repaired with a mesh and the wound closed in layers.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 15

    S/M/71yo

    84.66.35
    Chief complaint : Unable to defecate
    It has been suffered in 3 days before admission. History of
    having lump was found at his right inguinal for 1 years, the
    lump occured oftenly when patient doing an excessive job or
    straining, and the lump dissapeared when the patient resting.
    The lump has persisted for 7 days. Pain (+) inttermitenly.
    Nausea and vomitus (-), flatus (-). Micturation (+). History of
    chronic cough (+). History of fever (+) in this 3 days.
    History of smoking (-)
    History of past illness : DM (-), HT (-)
    History of previous surgery (-)
    Present State :
    • Awareness : Alert
    • BP : 140/90 mmHg
    • HR : 90 beats/minute
    • RR : 18 times/minute
    • Temp : 36.50 C
    • VAS Score : 3
    Generalized State
    • Head : No abnormalities was found
    • Neck : No abnormalities was found
    • Chest : No abnormalities was found
    • Abdomen : In localized state
    • Genital : Male, In localized state
    • Extremity : No abnormalities was found
    Localized state:
    • Abdomen:
    I : symmetrical, distention (-), visible bowel movement (-)
    A: peristatic (+) increase, metallic sound (-)
    P: liver dullness (+), tympani
    P: smooth, muscular rigidity (-)

    • DRE :
    Perineum was normal, Anal Sphincter Tone was tight,
    smooth mucosal layer, ampula recti was collapsed,
    mass(-), pain (-)
    Gloves : blood (-), feces (+),mucous (-).
    • Genitalia:
    Male, mass (+) on L) scrotum, soft consistency,
    smooth surface, well circumscribed, color similar
    to the surrounding skin, transillumination (-),
    pain (-), peristaltic (+), size 10x8x5 cm.
    Clinical
    Chest x-ray
    Laboratory Finding
    • Hb/Ht/Wbc/Plt : 16.5/49/16.170/213.000
    • Na/K/Cl : 135/4.2/105
    • Rapid Test anti Covid-19 : Non reaktif
    Working Diagnosis : (L) Incarcerated Lateral
    Inguinal Hernia + Susp. Covid-19
    Management at Emergency Department :
    • Fasting
    • IVFD Crystalloid
    • Inj.Antibiotic
    • Inj.Analgetic
    • Installation of NGT, came out clear liquid about 50 cc
    • Installation of Catheter, came out initial urine output
    about 100 cc with clear yellow colour
    • Plan for (L) Hernioraphy emergency
    Operation Theatre
    • Patient in supine position under Spinal
    Anesthesia, aseptic and antiseptic
    procedure was done.
    • Incision (L) inguinal oblique: cutis,
    subcutis, external oblique aponeurosis
    were divided
    • Both flaps were mobilized
    • Lifting sprematic cord from inguinal
    canal at pubic tubercle and then
    dissecting bluntly until the cord
    completely free
    • Sac was seen and opened.
    Sac content was small bowel
    and caecum approximately
    20 cm illeocaecal junction to
    caecum.
    • Internal ring was release,
    then identification of wedge
    area. Compressed with
    warm saline, and tactile
    stimulated, color
    reddish,peristaltic (+), seems
    viable.
    • Sac content returned
    to abdominal cavity.
    • Proximal and distal
    sac were separated
    and the proximal one
    was ligated at the
    preperitoneal fat.
    • A 15x7 cm prolene mesh
    was applied and fixated
    to tuberculum pubicum,
    conjoint tendon,
    inguinal ligament.
    • Bleeding was controlled,
    surgical wound was
    closed layer by layer.
    • Operation was done.

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