PPT pasien abses perianal 8 November 2021.pptx

Ppt pasien abses perianal

1. J/M/49yo 84.72.33

2. Chief Complaint : Pain on the perianal It has been suffered in 3 week before admitted to Haji Adam Malik Hospital. Previosly patient have a l ump since 1 month ago and increase progressively followed by production of pus. Fever since two days ago, nausea (+), vomiting (-). Micturition and defecation in normal limit. History of past illness : DM type 2, Hypertension History of medication : Metformin

3. Present State Awareness : Alert BP : 130/80 mmHg HR : 76x x/ i RR : 20 x/ i Temprature : 37,8 C Vas : 5  

4. Generalized State Head : no abnormalities was found Neck : no abnormalities was found Chest : no abnormalities was found Abdomen : no abnormalities was found Ano -Genitalia : In localized state Extremity : no abnormality was found

5. Abdomen I : symmetric al, distention (+) A : peristaltic ( + ) P : Soepel, tenderness (-). P : liver dullnes s (-), hypertympani (+) Digital Rectal Examination : Perineum normal , tight anal sphincter tone, smooth mucosal surface, pain (-), mass (-) , ampulla was filled with feces . Gloves : stool ( + ), blood (-) mucus ( - )

6. Localized State Ano -genitalia : Male, necrotic wound o/t scrotal Peri anal : necrotic wound with size 5x3cm, muscle base, irreguler edge, pain (+)  

7. Laboratorium Finding Hb/ Hct /WBC/PLT : 8,5/ 24,4/ 20,960/ 331.00 Na/K/Cl : 126 /3,2/94 Ur/Cr : 66/ 0,69 Albumin : 1,4 Glucosa ad random : 194

8. Working Diagnose Perianal abscess + Fournier gangrene + DM Type II + Anemia + Hyponatremia

9. Management at The Emergency Room Fasting IVFD Crystalloid 30 dpm Inserted catheter urine —> came out 100 cc, clear yellow , uop 70cc/hour Inj. Antibiotics —> Inj. Ceftriaxone 1 gr iv Inj. Analgetic —> I n j. Ketorolac 30 mg iv Transfusion PRC (10-8,5)70x4 = 420cc —> 3 bag Natrium correction (135-126)70x0,6 = 378 mEq NaCl3% 500cc + NaCl0,9% 500cc —> 10dpm Plan : Sigmoidostomy diversion + debridement  

10. In Operating Theatre Patient in supine position under spinal anasthesia , aseptic, antiseptic procedure. Contra McBurney incision, cutis, subcutis, aponeurosis, muscle was cut, peritoneum was opened. Identification of sigmoid, sigmoid was preserved with nelaton catheter. Proximal stump was on the lateral position and distal stump on the medial position.

11. Sigmoid was fixated to aponeurosis on 8 directions. Sigmoid was cut. Operation was continue to debridement

12. Necrotic and non viable tissue was removed. Performing curettage in necrotic tissue until the bleeding points.

13. Bleeding was controlled Wound was washed repeatedly with normal saline until clean. Identification sphincter, sphincter was loose , fistula (-) Inserting gauze antibiotic ointment into wound. Operation was finished.