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High Output FEC

1. KU : keluar kotoran dari luka post operasi RPS : Pasien datang dengan keluhan keluar kotoran dari luka bekas operasi sejak 2 hari SMRS. Awalnya keluar kotoran sedikit semakin lama semakin banyak . Kadang pasien sampai membasahi tempat tidurnya karena banyaknya kotoran yang keluar . Keluhan disertai keluarnya darah , nanah dari bekas jahitan , Nyeri perut (+), mual (+), muntah (+), nafsu makan menurun (+), riw demam (+) RPD : DM (-), HT(+), Ca Ovarium residif (+) . RPK: Riw . Alergi : (-) Keganasan (-) RPO : Operasi Oleh TS Obsgin Reseksi Tumor Rahim Oktober 2024 di RSUDP NTB Operasi Oleh TS Obsgin Reseksi Tumor Ovarium Residif + Double Barrel Ileostomy tgl 09/12/24 di RSUDP NTB Riw . Ajuvan Kemoterapi 7x (+) Mr s. S/49 yo/MR 216200 Admitted on Desember 31 th 2024 at 22.00 pm

2. Head & Neck Anemic conjunctiva (-/-), Icteric sclera (-/-) all of body Chest I : Symmetric respiratory movement (+) swelling (-/-), P : Symmetric VF, tenderness (-/-) crepitation (-/-) P : Sonor / Sonor A : Symmetric VBS (+/+), rhonchi (-/-), wheezing (-/-) Abdomen I : D istension ( - ), stoma (+) viable, dehiscence in the surgical wound, fecal products, volume >500ml/24 hours A : Bowel sound 12 -1 4 x/minutes, metallic sound (-) P : Tympanic (+), shifting dullness (-) P : D efans muscular (-), Tenderness (-), H/M/L Not palpable, hard palpable peristoma (+) Extrimities warm extremities (++/++), edema (--/--), CRT <2 Second PHYSICAL EXAMINATION VITAL SIGN GCS : E4V5M6  BP : 114/78 mmhg HR : 9 7 x/ mnt RR : 20 x/ mnt   T : 36. 8 °C SpO2 : 100 % on RA VAS5/10 pm ANOGENITAL RT: I: normal perianal anal perineum, mass (-), fistula (-) , mass (-) P : Ani sphincter tonus grip strong, Ampula recti colaps (-), mass (-) Handscoen: Feces(+), Blood(-),

3. CLINICAL PICTURE

4. Laboratory Finding on Dec 31 th 2024 at RSUDP NTB Examination Result Normal Value Hemoglobin 10.2 12,00-16,00 g/dl Leukosit 13.840 4,0-10,5 ribu/ul Eritrosit 3.77 3,90-5,50 juta/ul Hematokrit 33 37,00-47,00 vol% Trombosit 279400 150-450 ribu / ul Ureum 56 8 – 24 mg/dl Kreatinin 0.5 0.6 – 1.2 mg/dl SGOT 19 5 – 40 mg/dl SGPT 42 7 – 56 mg/dl Natrium 129 135-146 mmol/L Kalium 4.6 3.4-5.4 mmol/L Klorida 95 95-108 mmol /L GDS 158 <160 mg/dL HBsAg Nonreaktif Nonreaktif

5. Thorax Xray on December 31 th 2024 at RSUP NTB

6. DIAGNOSE Planning Treatment : Fasting NGT DC IVFD tutosol : triofusin : clinimix = 1:1:1 = 24 tpm Inj. Ceftriaxone 1gr/12 h IV Inj. Metronidazole 500mg/8 h IV Inj. Metamizole 500mg/8 hIV Inj. Omeprazole 40mg/12 h IV Caps NaCl 3x1 obsgyn specialist shared care High Output FEK in Patients with Residual Ovarian Ca Post Laparotomy Tumor Resection + Double Barrel Ileostomy + Hiponatremia (129) TREATMENT Diagnosis Planning: - Norit Test - Contrast Abdominal CT Scan Planning Surgery : - Laparotomy Exploratory Fistulectomy