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Diskusi kasus trauma

abdomen

Kasus 1 : Sigmoid colon perforation


e.c blunt abdominal trauma
Anamnesis
Seorang laki-laki berusia 40 tahun dibawa ke unit gawat
darurat RS dengan keluhan nyeri seluruh perut, mual dan
muntah sejak 2 jam yang lalu. Pasien mengalami
kecelakaan bermotor 1 hari yang lalu. Pasien mengakui
perutnya terbentur badan motor. Pada saat kecelakaan,
pasien tidak dibawa ke rumah sakit karena hanya
mengalami luka lecet pada tangan dan kaki.

Pemeriksaan fisik
Keadaan umum : tampak sakit berat
Kesadaran : komposmentis
Vital sign

Tekanan darah
: 110/70 mm Hg
Denyut nadi : 112 x/menit
Frek. Nafas
: 24 x/menit
Suhu
: 37,4C

Pemeriksaan abdomen : cembung, ekimosis pada daerah


umbilicus, distensi, rigiditas otot, nyeri tekan, nyeri lepas di
seluruh kuadran abdomen, hepar dan lien sulit dinilai.

Hasil pemeriksaan laboratorium didapatkan :


hemoglobin (9.9g/dL), jumlah leukosit (15.2 103
cells/L)
Pemeriksaan abdominal X-ray : tampak multiple air-fluid
levels.

Terapi :
Konsultasi ke dokter bedah
Laparotomi eksplorasi

Fecal contamination.
Ecchymosis around the umbilicus.

Sigmoid colon perforation.

Kasus 2 : liver injury after blunt


abdominal trauma
Anamnesis
Seorang laki-laki berusia 26 tahun dibawa ke unit gawat
darurat RS dengan keluhan nyeri perut kanan atas, mual
dan muntah darah setelah mengalami kecelakaan mobil
1 jam yang lalu. Pasien mengaku bagian perutnya
terbentur stir mobil. Pasien menyangkal dadanya
mengalami benturan.

Pemeriksaan fisik
Keadaan umum : tampak sakit berat
Kesadaran : somnolen
Vital sign

Tekanan darah
: 90/60 mm Hg
Denyut nadi : 110 x/menit
Frek. Nafas
: 32 x/menit
Suhu : 37,4C

Pemeriksaan mata : konjungtiva anemis (+/+)


Pemeriksaan abdomen : cembung, ekimosis pada daerah kuadran kanan
atas, distensi, rigiditas otot, nyeri tekan di kuadran kanan atas, hepar dan lien
sulit dinilai.
Pemeriksaan ekstrimitas: akral dingin, capillary refill > 2 detik dan pucat

Hasil pemeriksaan laboratorium didapatkan :


hemoglobin (8 g/dL), jumlah leukosit (15 103 cells/L)
Pemeriksaan abdominal X-ray : tampak air-fluid levels
Pemeriksaan USG
Abdominal sonogram shows a crescent-shaped
hyperechoic collection along the right lateral aspect
of the liver consistent with subcapsular hematoma.

Terapi
Resusitasi cairan untuk mengatasi syok
Lakukan tranfusi darah
Konsul ke dokter bedah laparotomy eksplorasi

Kasus 3 BLUNT TRAUMA LIVER


A 28 years old male patient was brought to Emergency
Room(ER) with history of Road traffic accident(RTA).
Patient was conscious, oriented and had pallor with BP
of 80/60 mm Hg. Urinary catheterisation revealed frank
hematuria. Abdomen was distended. Guarding, rigidity
and diffuse tenderness were present over the entire
abdomen.

Patient was resuscitated with crystalloids and whole blood when BP


improved to 130/80 mm Hg and pulse rate of 100/min.
Initial Ultrasound revealed grade 2 renal injury with moderate
hemoperitoneum, liver and other viscerae were normal.
As CT was nonfunctional on the day, urgent Intravenous Pyelogram
(IVP) was done which showed a non-enhancing Right Kidney.
Patient was shifted to Intensive care unit( ICU) and managed
conservatively.
Due to progressive drop in Hemoglobin despite adequate blood
transfusion, a repeat Ultrasonogram(USG) was done which picked
up an additional injury, a liver laceration of 3 x 2 cm.

Contrast CT Abdomen was done (18 hours after


admission) which showed liver laceration and grade 5
renal injury

In view of increasing tranfusion requirements,


emergency laparotomy through a midline abdominal
incision was done. Right Kidney was shattered with
renal vein injury. Right Nephrectomy was done. The
laceration in segment 5 of liver on anterolateral surface
of right lobe was packed with greater omentum and
hemostasis was secured.

Traumatic duodenal rupture in a


soccer player
A healthy 28 year old man was admitted to the
emergency department with acute midepigastric
abdominal pain, having been struck in the abdomen by
the knee of an opponent during a soccer game.
Blood pressure, pulse, and temperature were all normal.
Physical examination on admission showed a diffusely
tender abdomen with extreme rigidity, rebound
tenderness, and decreased bowel sounds.

Blood analysis showed a haemoglobin concentration of


15.7 g/100 ml, a white blood cell count of 7.4 109/l, a
C reactive protein concentration of <10 mg/l, and an
amylase level of 66 mg/100 ml. Urine analysis was
normal.
A contrast enhanced computed tomographic scan of his
abdomen showed retroperitoneal air and distension of
Contrast enhanced computed
the small bowel.
tomography scan showing
pneumoperitoneum.

Acute laparotomy showed a 2 cm transverse anterior


perforation between the descending and horizontal part
of the duodenum. The perforated edges were debrided
and closed in two layers. Recovery after the operation
was uneventful.

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