Program Studi Ilmu Bedah Fakultas Kedokteran UGM, Yogyakarta
Selamat Datang di Program Studi Ilmu Bedah Fakultas Kedokteran Universitas Gadjah Mada, Yogyakarta

Ilmiah

Epidural Hematoma Case Profiles Compatible for Exploratory Burr Hole in dr. Sardjito General Hospital and Affiliated Hospitals

 

Adiguno Suryo W1, Rahmat Andi Hartanto2

1. Resident of Neurosurgery, GMU Faculty of Medicine/RSUP Dr Sardjito Yogyakarta

2. Consultant Neurosurgeon, GMU Faculty of Medicine/RSUP Dr Sardjito Yogyakarta

 

Background

 

Epidural hematoma (EDH) is considered an emergency because the correlation between response time and patient prognosis is highly significant. A more immediate response results in better prognosis, as the intracranial pressure is rapidly decreased. Burr Hole Exploration is one of the neurosurgical procedures that may be performed by surgeons in areas with minimum supporting facilities or resources.

 

Method

 

This is a cross-sectional study with a descriptive study design that was carried out in RSUP dr. Sardjito, Yogyakarta and affiliated hospitals within the period of February 1st 2012 — March 30th 2012. The patients included in this study are those specifically suffering epidural hemorrhage only, with no other intracerebral bleeding sites.

 

Results

 

The researchers performing this study obtained 20 EDH cases, 6 (30 %) with presenting GCS of 14-15; 11 (55 %) with presenting GCS of 9-13, and 3 (15 %) with presenting GCS of GCS 6-8. Pupil sizes present consisted of 7 anisochoric cases; 3 among patients with the GCS of 6-8, 3 among those with the GCS of 9-13, and 1 with the GCS of 14-15. Ten (50%) patients suffered from linear head fractures, 1 (5%) suffered a depression head fracture, and 1 (5%) suffered diasthatic fracture.

Distribution of the number of cases corresponding to the region of the hematoma are as follows: 5 frontal, 5 parietal, 1 fronto-parietal, 2 parieto-occipital, 1 temporal, 3 temporoparietal , 1 temporo-frontal and 2 occipital. External lesions were found corresponding to the location of hemorrhage (coup) in 18 patients and not corresponding (countre-coup) in 1 patient. 7 (35%) patients are found to be compatible to undergo Burr Hole Exploratory.

 

Conclusion

 

The diagnosis and management of EDH must be done rapidly and thoroughly. 35% of patients in Yogyakarta presenting with signs of herniation are indicated to undergo Burr Hole Exploratory by surgeons with minimum supporting facilities or resources.

 

Keywords: EDH, Burr Hole Exploratory, Herniation



The Colon and Rectum Tumors Profiles in The Year of 2006- 2011 at RSUP Dr Sardjito Yogyakarta

 

Ardean Bernandito, Imam Sofii

Sub devision of digesty of Medical Faculty Gadjah Mada University

 

Background:Colon cancer or colorectal cancer is a malignant cancer which is included in the 10 most cases in the world. In 2008, the colorectal cancer was in the third rank of the cancer cases that happened in United States both in men and women

 

Method:This study is a descriptive research with retrospective samples which is taken since January 2006 until December 2011. The data is gathered from the medical records of the patients in RSUP Dr. Sardjito Yogyakarta. The samples which fulfills the inclusion criteria are taken as the data.

 

Result:From the 287 samples there are 119 male patients (41.5%) and 168 female patients (58.5%) with the age 20 is the youngest and 85 is the oldest (most of patients are in the age of 53 and 69, SD + 14.419. The percentage based on the main complaints of diarrhea is 34 patients (11.8%), constipation is 53 patients (18.5%), blood stool is 149 patients (51.9%), hard stool is 19 patients (6.6%). Based on the location of the tumour, in Ca Recti is 120 patients (41.8%), in Ca Sigmoid is 37 patients (12.9%), in colon transversum tumour is 25 patients (8.7%), in colon sinistra tumour is 6 patients (2.1%), in colon dekstra tumour is 19 patients (6.6%), and in ca cecum is 4 patients (1.4%). The supporting checks that are held are USG Abdomen on 72 patients (22.5%), photo thorax on 163 patients (56.8%), colon in loop on 53 patients, CT Scan Abdomen on 33 patients (22.5%), and colonoscopy on 39 patients (13.6%). The operations that are held are anastomosis resection 32.8%, delay anastomosis resection 29.3%, colostomi paliatif 11.1%, and Miles procedure 5.6%. The treatments to handle the recurrency that are held are chemotherapy 4.2%, radiotherapy 0.3%, and radiochemotherapy 5.2%. The stadiums of the tumours are Dukes A 1%, Dukes B 35%, Dukes C 38%, and Dukes D 5%.

 

Conclusion:The samples of this study are 287 patients consisting of 119 males (41.5%) and 168 females (58.5%). The youngest age of the patients is 20 and the oldest age is 85 (most of them are 53 and 69 years old, SD + 14.419). The most complain blood stool on 149 patients (51.9%), Most of the tumours are located in Ca Recti in 120 patients (41.8%). The operations that are held are anastomosis resection 32.8%, delay anastomosis resection 29.3%, colostomi paliatif 11.1%, and Miles procedure 5.6%. The treatments to handle the recurrency are chemotherapy 4.2%, radiotherapy 0.3%, radiochemotherapy 5.2%. The most stadium is Dukes C 38%.

Key words:Colorectal carcinoma, sex, age, tumour location, stadium

 



The Prognoses Factors That Influenced The Occurrence of Post-Endorectal Surgery Constipation of Pull Through at Dr. Sardjito Hospital

 

Ardean, Rochadi

 

Residence of General Surgery

Faculty of Medicine of UGM/Dr. Sardjito Hospital Yogyakarta

Division of Surgery Faculty of Medecine of UGM/Dr. Sardjito Hospital

Sub-Division of Pediatric Surgey Faculty of Medecine of UGM/Dr. Sardjito Hospital

 

Abstract

Background

The Hirschsprung disease is an disorder of clinical manifestation caused by the absence of Aurbach and Meisner ganglions.  The genetical factor was a main factor caused this disorder due to the neurochristopathical disturbance. The mortality rate of Hirschsprung disease on the untreated neonatus was so high, it reached to 80%, whereas the post-surgerical complicating constipation of ERPT was 42.2%.

 

Purpose

To get some informations related to the influencing factors of the occurrence of post-surgerical constipation of ERPT at the hospital of Dr. Sardjito Yogyakarta.

 

Method

This study was designed by retrospective observation.  Data was gathered using medical records and control data of poly.  Data was categorized by age, sex, birth weight, weight at surgery, albumen content, Hb and the occurrence of post-surgerical constipation of ERPT.

Data was collected from 2005-2010.

 

Results

This study used 66 samples and found post-surgerical constipations of ERPT in 6 patients (9.09%).  It did not find any significant correlation from the results between the occurrence of post-surgical constipation of ERPT and sex (p = 0.102), age (p = 0.660), birth weight (p = 0.135), weight at surgery (p = 0.667), Hb (p = 0.532), albumin content (p = 0.205).  There were 2 patients (3.03%) who died.

 

Conclusion

It was occurred post-surgerical constipations of ERPT in 6 patients (9,09%).  There were 2 patients (3.03%) who died.  It did not find any prognoses factor that influenced the post-surgerical constipation of ERPT, but there was a significant correlation between post-surgery constipation of ERPT and living resistence (p = 0.000).

 

Keywords: Hirschsprung Disease, ERPT, Constipation, Living Resistance

 



Case Report
Intra Cranial Migration of Peritoneal Ventriculo Shunt

Arif Septa Reno *Handoyo P **  
* Resident of General Surgery,  Gadjah Mada University /  Dr. Sardjito Hospital Yogyakarta
** Neurosurgery,  Gadjah Mada University / Dr. Sardjito  Hospital Yogyakarta

Abstract

 

Introduction
Migration of ventriculo peritoneal shunt is a rare complication incases of hydrocephalus following surgery. Only 5 cases ofintracranial migration of peritoneal ventriculo previously been reported. Migration to the distal been frequently reported. The change in pressure between the cranial and the peritoneum is a factor that determines the direction of migration.

Case
Reported in infants aged 6 months after the installation ofhydrocephalus shunts, with complaints of diarrhea and vomiting, and dehydration was suspected malfunctions ventriculo peritonealshunt.

Results and Discussion
Suspicion of shunt malfunction ventriculo peritoneal, abdominalexamination in the 3 position does not seem to get the impressionthe picture ventriculo peritoneal shunts, head ofthe secondexamination in a position to get an overview lusensi multiple (2) theprojection of theleft et frontoparieal artery proximal to the tip of thehose ventriculo peritoneal shunts in vertex projection sub parietal,and axial CT scan of the head in get theimpression hydrocephaluset causa non comunican blockage in aquaductus cerebri and endsventriculo peritoneal shunts in the lateral ventricle artery.

Resume
In the report the migration of peritoneal shunt into the intracranialventriculo in patients with hydrocephalus after installation ventriculoperitoneal shunt.

Keywords: Hydrocephalus, intracranial migration of peritoneal ventriculo shunt

 



Prognosis of Inhalation Trauma

Acute Lung Injury and Acute Respiratory Distress Syndrome

Victims Eruption of Mount Merapi Dr. Sardjito Hospital in 2010

Arif Septa Reno * Rosadi  S **
* Resident of General Surgery, Gadjah Mada University / Dr. Sardjito
Hospital Yogyakarta
** Sub-section Plastic Surgery, Gadjah Mada University / Dr. Sardjito
Hospital Yogyakarta.


Abstract

Introduction
Vulcanic eruption of Mount Merapi in Yogyakarta carrying injuries and fatalities, most victims suffered burns and cared for in Dr.Sardjito hospital.

Method
A total of 42 patients treated victims of Merapi eruption in Dr. Sardjito hospital, secondary data retrieval using medical records and laboratory data. Data of blood gas analysis, comparison with the oxygen pressure of oxygen fraction 200-300 assessed as Acute Lung Injury, the ratio of oxygen to the fraction of oxygen pressure below 200 rated assessed as acute respiratory distress syndrome.

Results and Discussion
Merapi eruption affected patients by 27 patients (64.3%) died and 15 patients (35.7%) live. Patients with inhalation trauma as many as 33 people (78.6%), without inhalation trauma as much as 9 (21.4%). In patients with inhalation trauma as many as 33 people in which patients died were 26 (78.8%), 7 person living patients (21.2%). Patients with extensive burns> 50% there are 21 people (50%) and patients with extensive burns 50% with inhalation injury there were 21 people (50%) in which 20 people (95.2%) of them died and only 1 patient (4.8%) are alive. Patients with extensive burns A total of 33 patients with inhalation trauma examination blood gas analysis in the emergency room as many as 31 people (93.9%) and that no examination of blood gas analysis by 2 people (6.1%). Results of the blood gas analysis patients who does not include Acute Lung Injury and Acute Respiratory Distress Syndrome who live as many as 3 people (42.9%) and 4 people who died (57.1%). Patients with Acute Lung Injury lives 0 personand patients who died 6 people (100 %). Acute Respiratory Distress Syndrome patients live as many as 3 people (16.7%) and 15 people who died (83,3 %).

Conclusion
Patients with inhalation trauma has a high mortality rate.

Keyword: The eruption of Merapi, burns, Acute Lung Injury, Acute Respiratory Distress Syndrome, Inhalation trauma

 



Comprehensive Classification of Head Injury

 

Enrico Gahara* , Wiryawan Manusubroto**

*Surgery Department, Faculty of Medicine Gadjah Mada University / Sardjito Hospital, Yogyakarta

**Neurosurgery Sub Department, Faculty of Medicine Gadjah Mada University / Sardjito Hospital, Yogyakarta

 

 

ABSTRACT

 

Background :The incidence of head trauma cases have a high enoughpercentage of the trauma cases, which usually occurs due to traffic accidents. This such mechanism is usually the result of high velocity traumamechanism so that the diagnosis, as a result not only stand-alone  but also has another concomitant injury.

 

Purpose :Developing a classification that is more specific and comprehensive  so that others importantabnormality is not neglected.

 

Material and Method :Retrospective studies have been done by taking a secondary datafrom the patient’s medical records in Dr. Sardjito Hospital, Yogyakarta. Study sample are patients with head injuries, which having major injury and concomitant including comorbid andextra-cranial injury.

 

Result : There are 94 head injury cases which are  diagnosed through a Computed TomographyScan that came into Emergency Room, most of them is not a single injury, but followed by concomitant injuries either intracranial orextracranial.

 

Conclusion : Sugesting the comphrehensive head injury classification which is more detail and comphrehensive for preventing under treatment and errors in caring

 

Keywords :Head injury, classification, intra cranial injury, extra cranial injury

 



Pengelolaan Luka Kronis Karena Listrik Regio Antebrachii Dengan Ekspose Tulang Dengan VAC ( Vacuum Assisted Closure ) Sederhana

Enrico Gahara *, M Rosadi Seswandhana **

* Bagian Bedah FK UGM /  RSUP Dr. Sardjito

** Sub Bagian Bedah Plastik FK UGM / RSUP Dr. Sardjito

 

Latar Belakang

            Luka kronis merupakan suatu proses penyembuhan luka yang gagal dimana fungsi secara anatomis dan fungsional tidak tercapai sebagai hasil akhirnya.     

Arus listrik menimbulkan kelainan karena rangsangan terhadap saraf dan otot. Energi panas yang timbul akibat tahanan jaringan yang dilalui arus menyebabkan luka bakar pada jaringan tersebut dan dapat menyebabkan sindrom kompartmen.

Terapi luka tekanan negatif atau Vacuum assisted wound closure dipercaya memiliki keunggulan. Terdiri dari penggunaan spons diantara luka, dilapisi pembalut yang kedap udara sehingga tercipta kondisi vakum.  Metode ini biasa digunakan bagi persiapan dasar luka untuk penutupan luka melalui operasi.

Terapi tekanan negatif bekerja dengan mekanisme kombinasi. Mekanisme penting adalah mengurangi edema, menghilangkan transudat periselular dan eksudat luka sehingga meningkatkan difusi oksigen interstisial ke sel.

Material

Laki – laki 53 tahun dengan riwayat trauma listrik pada ekstremitas 2 bulan sebelumnya menderita luka kronis pada bagian ventral dari lengan bawah dengan ekspose tulang. Dilakukan terapi luka dengan tekanan negatif secara sederhana selama  4 hari dengan hasil luka kronis memiliki granulasi yang baik. Luka cocok dilakukan intervensi berikutnya, dalam hal ini dilakukan Groin flap.

 

VAC sederhana

 

Metode

Laporan kasus

Kesimpulan

            Hasil pengelolaan luka kronis akibat listrik dengan tekanan negatif memberikan  jaringan granulasi yang baik. Pengelolaan tekanan negatif dilakukan dengan alat – alat sederhana. Dengan jaringan granulasi yang baik, intervensi berikutnya dapat dilakukan, dalam hal ini dilakukan Groin flap.

 

Kata Kunci       : luka kronis, trauma listrik, tekanan negatif, modifikasi VAC, VAC sederhana

 



Management Profile in Phyllodes Tumor at Sardjito General Hospital From 2009-2011

Francisca Christauriza* , Herjuna Hardiyanto**

*Surgery Dept. FK UGM/RSUP Dr. Sardjito Yogyakarta

**Oncology Surgery FK UGM/RSUP Dr. Sardjito Yogyakarta

 

ABSTRACT

BACKGROUNDS

Breast phyllodes tumors are rare fibroepithelial neoplasms that need to be distinguished from the common morphologically similar fibroadenomas, because phyllodes tumors can recur and progress to malignancy. The study addresses the controversial prognostic and therapeutic aspects of phyllodes tumor of the breast

METHODS:

We collected all af Medical Records of the patients with diagnosed Phyllodes tumor histologically from January 2009 untill December 2011. Then we reviewed the Medical Records for the kind of the treatment for that diagnosed and we noted it and grouping it according to the group.

RESULTS:

Records of 15 women with phyllodes tumor of the breast were reviewed. On the basis of the criteria proposed by Azzopardi and Salvadori et al., including estimation of tumor margin, growth of the connective tissue component, mitoses, and cellular atypia, the entire series was divided into two histotypes of phyllodes tumor, i.e., benign (6 cases, 40%), and malignant (9 cases, 60%). One patients (6,67%) were treated by wide excision and it was benign, 10 (66,67%) by simple mastectomy (4 benign, and 6 malignant), and 4 (26,27%) by radical mastectomy (all malignant).

CONCLUSIONS:

Management of phyllodes tumor in Sardjito General Hospital in three past year was most of the case treated with the simple mastectomy. Only one patient was treated with wide excision and the other still need the modified radical mastectomy. The choice of treatment was based on the clinically finding during operation and had confirmed by the result of the histological finding from the anatomical pathology laboratories.

 

Keywords: phyllodes, mastectomy



Squamous Cell Carcinoma Treatment in The Facial Region at Sardjito General Hospital

Francisca Christauriza* , Herjuna Hardiyanto**

*Surgery Dept. FK UGM/RSUP Dr. Sardjito Yogyakarta

**Oncology Surgery FK UGM/RSUP Dr. Sardjito Yogyakarta

Abstract

OBJECTIVES:

Squamous cell carcinomas usually remain confined to the epidermis (the top skin layer) for some time. However, the larger these tumors grow, the more extensive the treatment needed.

Metastases most often arise on sites of chronic inflammatory skin conditions and on the ear, nose, lip, and mucosal regions, including the mouth, nostrils, genitals, anus, and the lining of the internal organs. Because most treatment options involve cutting, some scarring from the tumor removal should be expected. This is most often cosmetically acceptable when the cancer is small, but removal of a larger tumor often requires reconstructive surgery, involving a skin graft or flap to cover the defect.

 

MATERIALS AND METHODS:

Two patients diagnosed histologically with squamous cell carcinoma in the facial region, were treated surgically by hemimandibulectomy with K-wiring and performed with musculus pectoralis major flap.

 

RESULTS:

The choice of treatment is based on the type, size, location, and depth of penetration of the tumor, as well as the patient's age and general health. In both of these patients, have been succesfully performed hemimandibulectomy with K-wiring, but during the follow up both of them had wire exposed and need some surgical procedure to correct it. After the improvement surgical procedure, one of the patient have a good result and the wound have been closure perfectly. The other, the wound cann’t closure well so it still opened wound, wet, purulent, and tend to be necrotic wound.

 

CLINICAL RELEVANCE:

This study provides modern treatment strategies for squamous cell carcinoma in the facial region.

Keyword: squamous cell carcinoma, hemimandibulectomy, flap



Meningioma In Pregnancy

 

I Gusti Putu Victor Widnyana1, Rahmat Andi Hartanto2

1. Resident of Generalsurgery, GMU Faculty of Medicine/RSUP Dr Sardjito Yogyakarta

2. Consultant Neurosurgeon, GMU Faculty of Medicine/RSUP Dr Sardjito Yogyakarta

 

 

Abstract

Introduction

Meningioma is one of the most frequent types of brain tumor in adults. It remains an issue that can not be resolved by the neurologists, neurosurgeons, and oncologists. Meningioma is 15-20% of brain tumors and 10-15% of all meningiomas considered as malignant tumors. The incidence of meningiomas in women higher than men. Tumor growth is stimulated by female sex hormones that lead to rapid growth in pregnancy or breast cancer.


Clinical symptoms such as nausea, vomiting, and convulsions sometimes misdiagnosis with hyperemesis gravidarum in early pregnancy and preeclampsia in late pregnancy age. Abnormal fundoscopy examination, vision disturbances, focal seizures, lateralization of neurological deficits supporting the diagnosis of intracranial masses and then further tests should be performed using a CT scan or MRI for diagnosis.

 

Case Description

 

Women, 34 years old, G5P4A0, 30 weeks of pregnancy with impairment of consciousness (GCS E3V5M4). Since seven years prior admision, patients have often felt an intermittent headache. Headache felt worse in the past year. Ten months before admission, the patient perform a CT scan of the head and was diagnosed as meningioma. But the patient refused to do the surgical removal of the tumor at the time and chose to do alternative medicine. Perceived symptoms of patients continued to deteriorate up to 15 days before admission the patient had weakness in both lower extremities. The patient was not able to walk alone and should be assisted by others. Three days before admission the patient fell because it had total weakness on both lower extremity. The patient was then taken to one hospital in Purworejo but the situation continued to deteriorate until the occurrence of impairment of consciousness then eventually refer the patient to the dr. Sardjito hospital, Yogyakarta. Then the patients underwent surgical removal of the tumor as well as termination of pregnancy. Anatomical pathology results showed a transitional meningioma grade I.

 

Key Words : meningioma, pregnancy

 


Case Report

Meckel’s Divertikel

Lokananta Irene*

Agustriani Nunik**

 

*Resident of Pediatric Surgery Dept,Sardjito hospital/Faculty of Medicine Gadjah Mada University Yogyakarta

**Sub division of Pediatric Surgery Dept,Sardjito hospital/Faculty of Medicine Gadjah Mada University Yogyakarta

 

Abstract

Meckel’s Divertikulum is a congenital anomaly, it is a divertikula that protuse from the wall of small intestine. In most cases, Meckel’s divertikulum is asymptomatic. But in few patient this can become an infection called divertikulis that causes symptom similary to appendicitis. This similarity happens because divertikulum makes intraluminal obstruction that causes inflammation, oedema, ischemia, necrosis, and perforation. Meckel’s divertikulum also causes internal herniation or volvulus.

A nine years old boy referred to Sardjito Emergency Department with chief complain of severe abdominal pain and distended since 2 day before admitted hospital. We diagnosed the patient as general peritonitis due to appendicitis perforation. But during the operation we found Meckel’s divertikel with midgut volvulus. We also identified apendix and we found apendix was normal form in retrocaecal. We decided to make exploratory laparatomy anastomosis resection ileoileal end to end and incidental appendectomy.

The boy was hospitalized eight days afer the operation. His condition was good and can went home. In the next controlled he has no complain.

 

Conclussion: The lesson from this case is there’s need more attention in anamnesis dan physical examination to make accurate diagnosis in order to decrease morbidity and mortality.

 

Keyword: Meckel’s Divertikel, Midgut Volvulus, Appendicitis.

 



Laparoscopic-assisted Versus Open Surgery for Rectal Cancer in Dr. Sardjito Hospital Yogyakarta

 

Iswadi, Hendro Wartatmo, Imam Sofii

Digestive Surgery Sub Division, Department of Surgery Dr. Sardjito Hospital Yogyakarta

 

Abstract

 

Background

The aim of this study was to compare the short-term outcome for consecutive patients undergoing either laparoscopic or open rectal resection for cancer at DR Sardjito Hospital in Yogjakarta.

 

Patients and Methods

Retrospective data collection all patients with rectal cancer admitted to our institution from January 2011 to Descember 2011 were included in the study. Patients who underwent emergency operation were excluded. Patients were given the option of laparoscopic or open colectomy and asked to choose after thorough explanation of the pros and cons of each procedure.  The data were analyzed using computer program statistical package SPSS (Statistical Package For The Social Science) version 17.0.

 

Results.

The study included 12 patients, 5 patients 41,67% with milles laparoscopic and 7 patient 58,33% with open milles laparotomy procedures. The length of hospital stay for the conventional group was significantly longer than that of laparoscopic group (10 days; p < 0.020). Furthermore, laparoscopic surgery offers decreased rate of blood loss (300 cc; p < 0.020).

 

Conclusion. Laparoscopic resection is a safe and feasible method of operation for rectal cancer it also offers decreased rate of blood loss and shorter lengths of hospital stay. However, longer follow-up duration and larger sample sizes will be needed to reveal definitive long-term results of

laparoscopic-assisted surgery.

 

Key words: Rectal cancer, Milles Procedure, laparoscopic.

 



Acute Hemorrhagic Pancreatitis, A Case Report

 

*Lauhil Mahfudz, **Hendro Wartatmo

*Resident of surgery, Faculty of medicine Gadjah Mada University / RSUP dr. Sardjito

**Division of Digestive surgery, Faculty of medicine Gadjah Mada University / RSUP dr. Sardjito

 

 

Abstract

Background: Patients with severe necrotizing pancreatitis can progress to a critical condition within a few hours or days after the onset of symptoms. The mortality in cases of acute hemorrhagic pancreatitis is variously quoted as 33% - 100%, because of this, it is advocated prompt surgical intervention in patients with this clinical diagnosis. With surgical treatment, the mortality rate for patients with pancreatic necrosis could be decreased to approximately 20% in various specialized centers. There is general consensus that infected necrosis is an indication for surgical treatment or interventional drainage. The therapeutic approach must be directed towards mechanical removal of infected necrotic tissue and drainage.

 

Case Report: A 42 years old male,admitted with complains of severe abdominal pain of all abdominal regions, febrile and frequent vomiting for over 2 days. On physical examination we found a sick-looking man in moderate pain general status with stabile vital signs, pain of all abdomen region with tenderness of upper right quadrant clinically, without jaundice or cyanosis. An abdominal ultrasonography was performed, with findings enlargement of liver, spleen, and pancreas size but still in normal structure. Also mentioned enlargement and thickened of gall bladder wall with multiple gallstones. And the conclusion was hepatomegaly, Cholecystitis, and cholecystolithiasis. The laboratory finding was leukocytosis, with slight shift to left on white blood counts, increasing amylase and lipase serum level, and also rise in alkaline phosphatase serum level. On patient was performed laparotomy drainage with biopsy from omentum. The histopathology conclusion was necrotic omentum tissue with polymorfonuclear leukocytes. The result from operation procedure was satisfactory, the patient was healed and outpatient 2 weeks later after procedure.

 

Keywords: Hemorrhagic pancreatitis, surgical treatment, laparotomy drainage, necrotic omentum tissue

 



Penanganan Operatif Pada Pasien Dengan Fraktur Depresi Tertutup

Novelia Dara Monika, Handoyo Pramusinto

Bagian Bedah, Fakultas Kedokteran Universitas Gadjah Mada, RSUP dr.Sardjito, Yogyakarta.

 

ABSTRAK

Pendahuluan:

Fraktur depresi dapat diartikan sebagai fraktur dengan tabula eksterna pada satu atau lebih tepi fraktur terletak dibawah level anatomi normal dari tabula interna tulang tengkorak sekitarnya yang masih utuh. Fraktur ini terjadi jika energi benturan relatif besar terhadap area benturan yang relatif sempit. Fraktur kranial berdasarkan gambaran frakturnya dapat dibagi menjadi : fraktur linier,faktur diastase, fraktur comminutif dan fraktur depresi. Berdasarkan lukanya fraktur kranial dibedakan sebagai fraktur tertutup, dan fraktur terbuka. Fraktur depresi baik yang tertutup maupun yang terbuka berkaitan dengan peningkatan insidensi lesi intrakranial, defisit neurologis dan hasil akhir yang jelek. Secara konvensional, pada kasus fraktur depresi tertutup dapat dipertimbangkan untuk dilakukan operasi apabila luas dari fragmen yang terdepresi lebih besar dibandingkan seluruh ketebalan calvaria yang terlekati dengan keuntungan kosmetik yang lebih baik, berkurang kejadian epilepsi pasca trauma, dan pengurangan insidensi defisit neurologis yang menetap.

Laporan kasus: Dilaporkan seorang laki-laki 36 tahun, datang dengan keluhan penurunan kesadaran setelah kejatuhan tabung gas elpiji sehari sebelum masuk rumah sakit.. Pasien tidak pingsan tetapi mengeluh pusing. Darah keluar dari  telinga dan hidung, namun disangkal keluar cairan kuning bening. Tidak ada keluhan mual dan muntah. Tidak ada kejang dan kelemahan anggota gerak. Dari pemeriksaan fisik didapatkan tekanan darah 140/90 mmHg, nadi 80 x/menit, respirasi 20 x/menit, suhu 36,5 ºC. Tampak vulnus laceratum di regio supraorbita sinistra dan hematom di periorbita sinistra et dextra.  Dilakukan pemeriksaan CT scan dan diperoleh gambaran fraktur depresi di os.frontal sinistra lebih dari 1 diploe dan fraktur zigomaticomaxilla komplit sinistra.

Pada hari ke 5 perawatan dilakukan debridemen dan koreksi pada fraktur depresi dan pemasangan IDW-IMW serta koreksi ORIF dengan miniplate untuk fraktur zigomaticomaxilla komplit. Saat operasi didapatkan fraktur depresi di os frontal sinistra sampai rima obita. Selama perawatan baik sebelum maupun sesudah operasi tidak didapatkan gejala kejang dan demam. Pasien pulang di hari perawatan ke 13 dalam kondisi baik, tidak ada keluhan demam, pusing ataupun kejang.

Kesimpulan: Fraktur depresi tertutup tidak mengalami kerusakan galeal sehingga pilihan penanganan melalui operasi dipilih hanya jika luas dari fragmen yang terdepresi sama atau melebihi ketebalan tulang berdekatan yang masih utuh, atau jika terdapat hematom intrakranial yang menimbulkan efek massa dan membutuhkan evakuasi. Penanganan operatif pada kasus fraktur depresi tertutup diharapkan mampu mencegah terjadinya kejang atau epilepsi pasca trauma dan komplikasi berupa infeksi.

Kata Kunci: fraktur kranial, fraktur depresi tertutup, penanganan operatif



Perikardiektomi Pada Perikarditis Konstriktiva Et Causa Infeksi Tuberkulosis

Novelia Dara Monika, Haryo Aribowo

 

Bagian Bedah, Fakultas Kedokteran Universitas Gadjah Mada, RSUP dr.Sardjito, Yogyakarta.

 

ABSTRAK

Pendahuluan:

Perikarditis TB merupakan salah satu kasus TB ekstra-paru dengan angka kejadian 20 % dari seluruh penderita TB. Perikardium dapat terinfeksi mikobakterium TB secara hematogen, limfogen ataupun penyebaran langsung. Penyebaran tersering karena infeksi di nodus mediastinum,secara langsung masuk ke perikardium, terutama di sekitar percabangan trakeobronkial. Efusi pericardium dan tamponade jantung merupakan salah satu bentuk komplikasi perikarditis TB. Penimbunan cairan akan mengganggu pengisian diastolik ventrikel kanan sehingga menurunkan isi sekuncup (strokevolume). Hal ini diimbangi oleh mekanisme kompensasi berupa takikardia dan peningkatan kontraksi miokardium. Tetapi jika mekanisme kompensasi ini dilewati,curah jantung (cardiac output) menurun maka akan terjadi gagal jantung, syok sampai kematian.

 

Laporan Kasus : Dilaporkan seorang perempuan 16 tahun, datang dengan keluhan sesak napas sejak 2 minggu sebelum masuk rumah sakit. Semakin hari sesak napas semakin bertambah, dan tidak berkurang dengan istirahat, Pasien juga mengeluhkan nyeri dada yang terkadang muncul. Terdapat demam yang hilang timbul. Riwayat batuk diakui sejak sesak napasnya muncul. Riwayat batuk lama sebelum ini disangkal. Riwayat mual muntah disangkal, namun makan dan minum pasien berkurang sejak bulan terakhir ini. Berat badan dirasakan menurun. Dari pemeriksaan fisik didapatkan keadaan umum pasien tampak sesak, compos mentis, dan gizi kurang. Tekanan darah 130/85 mmHg, nadi 124 x/menit,regular, isi dan tegangan lemah, respirasi 40 x/menit, suhu 38 ºC. Pada pemeriksaan paru : sonor di hemithorax kanan, dan redup di hemithorax kiri mulai setinggi SIC III ke bawah. Vesikuler positif pada paru kanan dan menurun pada paru kiri setinggi SIC III. Jantung : ictus cordis tidak teraba, BJ I-II tunggal, regular, lemah, tidak ada bising jantung. Dilakukan pemeriksaan rontgen thorax dan diperoleh hasil terdapat gambaran efusi pleura kiri dan curiga efusi pericardium, lalu dilakukan echocardiografi dan diperoleh hasil adanya efusi pericardium.

Pada hari ke 3 perawatan dilakukan pericardial window dan ditemukan adanya perikarditis konstriktiva dan efusi di pericardium dalam jumlah tidak terlalu banyak dan efusi pleura kiri. Dilakukan perikardiektomi, dan pengaliran cairan pericardium serta pleura melalui selang dada. Pada analisa cairan pericardium dan pleura serta hasil biopsi jaringan pericardium ditemukan sel-sel radang dan tuberkel yang mengarah ke TB. Pasien kemudian memperoleh terapi OAT. Selama perawatan setelah operasi, klinis pasien membaik. Pasien dipulangkan di hari perawatan ke 15 paska operasi dalam kondisi baik, tidak ada keluhan sesak, nyeri dada, batuk dan demam.

 

Kesimpulan : Penatalaksanaan kasus perikaditis TB dengan efusi pericardium paling baik dengan kombinasi antar terapi pembedahan dan terapi medikamentosa, yaitu dengan OAT, pericardial window dan perikardiektomi.

 

Kata Kunci: efusi pericardium, pericardial window, perikardiektomi, perikarditis TB



Rhinophyma : Treatment with surgical Sharp Scalpel approach

Nur Eko Hadi Sucipto * Ishadono Dahlan * *
*) Resident Surgeon, Dr.Sarjito Hospital, Yogyakarta / Gajah Mada University
**) Department of Plastic Surgery Dr.Sarjito Hospital, Yogyakarta / Gajah Mada University



Introduction : Rhinophyma is a state where gladula sebase enlargement of the nose, where the further state can be rosacea, patients with rhinopyma usually occurred in people who are at extreme temperatures, hot liquids, alcohol, and the workers are exposed to sunlight directly. Rhinophima most often occurs in consuming alcohol.

Sebaceous glands on rhinophyma  experience growth of excess, sebaceous gland as an oil called sebum, which is composed of fat and debris produced by fat cells that are already dead. Sebum is produced to provide lubrication to the skin, but if the person is poor hygiene, diet and condition in which excess fat over activity of sebaceous glands there will be a rhinophyma.

Therapy of rhinopyma is to remove the cause as well as the surgical approach is by using sharp Scalpel approach

Purpose: The goal of therapy in patients with Rhinopyma is to eliminate the trigger and using medical approach by using surgical Sharp Scalpel.

Material and Methods: There have been treatment case studies in patients with rhinophyphima at a private hospital in Yogyakarta with the integral approach to the surgical Sharp Scalpel
Conclusion: patients with rhinophyma with the surgical Sharp Scalpel approcach showed satisfactory results.


Keywords: Rhinopyma, surgical Sharp Scalpel



Case series

Vaccum Assisted Closure (VAC) In Wound Management


Nur Eko Hadi Sucipto * Rosadi Seswandana **
*) Resident Surgeon, Dr.Sarjito Hospital, Yogyakarta / Gajah Mada University
**) Department of Plastic Surgery Dr.Sarjito Hospital, Yogyakarta / Gajah Mada University


Introduction : Wound healing that takes long period of time is a significant problem, especially in patients with old age because it would interfere with the quality of life of the person.
Vaccum Assisteted closure (VAC) is one alternative that can be used on the wound healing process, this tool uses a negative pressure to reduce the accumulation of transudate or exudate in the wound, especially in chronic wounds, reduce edema, reduce pain, and can make efficient use of gauze in the wound treatment.

Methods and Results: The cases were reported in patients with chronic wounds, patients treated in the department of Plastic Surgery, Dr.Sarjito Hospital, Yogyakarta performed using the method of treatment with VAC modification of the department of plastic surgery,  Dr.Sarjito Hospital, Yogyakarta. In the three patients who were treated with chronic and acute wound conditions obtained good results, including a more rapid wound healing in time, do not wet as well as good growth of granulation tissue.

Conclusion: VAC is one tool that can be used for the treatment of chronic and acute wound healing after the use of tools in wound area  showed satisfactory results.

 

Keywords: Wounds, Wound Management, Vaccum assisted closure (VAC)

 

 

Renal Function In Patients Burn Injury
Merapi Eruption Victim
Aretreated At Dr Dr Sarjito Yogyakarta

 

Rianto, Rosadi

 

Residence of General Surgery

Faculty of Medicine of UGM/Dr. Sardjito Hospital Yogyakarta

Division of Surgery Faculty of Medecine of UGM/Dr. Sardjito Hospital

 

Abstract

Background

The burnis theexposure ofthe humanbodyby asubstanceof high temperature(heat) orwhichcanlead tohigh temperatures, either due tochemicalreactionsandphysicalreactions. The burnis a type ofinjury, tissue damageortissue lossresulting fromthe heat sourceorcoldtemperaturesarehigh, the source ofelectricity,chemicals, light, radiationandfriction. Types of injuriescan bediverse andhavedifferenttreatmentdepending on thetype oftissueaffected byburns, severity, andcomplicationsfrom the injury. Burns candestroymuscletissue, bone, bloodvesselsandepidermaltissuedamageresultingina deeper placethanthe end ofthe neuralsystem. Aburnvictimmay experiencea variety ofpotentially fatalcomplicationsincludingshockconditions, infections, electrolyteimbalance, organfailure, respiratorydistressandproblems.

Purpose

To know thecomplicationsofsevere burnsonvictimsof acuterenal failuretreatedMerapi eruptioninDRSardjitoHospitalYogyakarta..

Method

The study designisdescriptive. Dataretrievedfrommedical records. Medical records of patientswhomeetthecriterianotedby age, gender, area burned,andthe glomerular filtration rate.Thenincludedin the table.

Results

Subjects wereall patientsof burnsvictimseruptionthat comesinto the ERandtreated inthe department ofDr. Sardjitoin 2010. Totalof allpatientswere 43menwithmale genderwas 27menandwomen16.Patientswithagelessthan 20yearsas many as8 people, patientswithage20-40 yearsas many as14 people, ages41-60years oldpatientwithas many as15 peopleandpatientswithageabove 60yearsas many as6 people. Patientswith a total of42 peopletherewas obtained21 patients(48.8%) died and22 patients werealive(51.2%). Of the21 patientswhodiedResultsGFRstage 1: 4.76%, stage 2: 4.76%, stage 3: 33.33%, stage 4: 33.33%, stage 5: 23.82%.

Conclusion

In this research,whichfoundthat90.48% victims ofthe eruption ofMount Merapi, who died sufferedextensiveinjuriesimmortalwith>50%, of course,this can leadto a substantial amountof fluidloss, andcan decreasebloodflowto the kidneysandcauses asevereimpairmentof renal functionand cancause death, althougha lot of thingsto be a complicationof burnsthat cancause death.
Theobservationalsofoundan increase inserumcreatininelevelson day5of theonset ofthe burnincidentandbegan to lookbackcreatinine levelsdecreasedfrom day-7 of theonset ofthe burnincident, this should make usmorevigilanton day5 towithday-to-7 forkidneyfailure eventsthat can providemortalityin burn patients.

 

Keywords: burn injury, GFR

 



Skull Fracture Management In Sardjito Hospital

 

Rianto* Wiryawan**

 

*Residence of General Surgery

Faculty of Medicine of UGM/Dr. Sardjito Hospital Yogyakarta

*Division of Surgery Faculty of Medecine of UGM/Dr. Sardjito Hospital

Sub-Division of Neurosurgery Faculty of Medecine of UGM/Dr. Sardjito Hospital

 

ABSTRACT

Introduction

Linear skull fractures or non-linear in children that increase with time is  called growingskull fracture.The lession is often found in children under the age of 3 years.

Case

Patient a woman aged 11 years came to   Neurosurgery  RSUP Sadjito with complaints lump behind the left ear, a lump is known as the age of 3 years. On clinical examination the patient left parieto-ocipital mass  obtained 15x12x4cm  size ,palpable was soft, no pain, no CSF  leakage.  Other physical examination  within  normal limits. The  head CT scan obtained: defect in the left parieto-ociptal and we  diagnosed of this patient as a skull  fracture.

M.ei 14th 2012 patients performed the operation,  a linear incision over themass performed, we found the capsule, the capsule was released from the tissue around by the blunt disection, the capsule was opened, we found  the brain tissue that become gliosis already , wed ecided toexcision of the capsule and the brain tissue which  had gliosis  and close the defect.

The importance of early diagnosis in the prior action, especially for general surgery practitioners be more vigilant when it finds the case in the region,  is expected to performed CT-scan of the head to find whether a mass or tumor that is located  have a relationship  with intracranial part on the head, in order to reduce moribiditas evenmortality in patients with tumor pat on the head.

Keywords : growing skull fracture



Profil Penderita Karsinoma Buli Di RSUP Dr. Sardjito Yogyakarta Periode Tahun 2010-2011

dr.Rido Octavianus Sitorus*, dr.Indrawarman, Sp.U**

*Residen Bedah Umum Universitas Gadjah Mada Yogyakarta, **Subdivisi Urologi RSUP dr.Sardjito

 

Abstract

Introduction

The bladder carcinoma is the most oftenly found fierceness on the tractus urinarius and the second highest fierceness found in the urogenital system after the prostatate carcinoma. This study was conducted to described the profile of the patients with bladder carcinoma in Yogyakarta based on the age and ex.

Methods

This study was performed in all of outpatients with bladder carcinoma in the polyclinic of urology of Sardjito Hospital in the period of January 2010 to December 2011.

Result

There were 125 outpatients treated during the period of two years and it was also found the increase of patients by 23% with the average age of 63 years old (2010) and 57 years old (2011). Totally, the male outpatients were greater compared with the female outpatients.

Discussion

All of outpatients with bladder carcinoma have to be treated periodically, and it has to be routinely conducted the clinical treatment, urine cytology and cystoscopy.

Keywords: bladder carcinoma, tractus urinarius

 



Spina Bifida Pada Anak

dr.Rido Octavianus Sitorus* dr.Handoyo Pramusinto, Sp.BS**

*Residen Bedah Umum Universitas Gadjah Mada Yogyakarta **Subdivisi Bedah Saraf RSUP dr.Sardjito

 

 

Abstract

Introduction

Spina bifida is an opening in the vertebral column caused by the failure of the neural tube to close properly or to fully develop. This defect is associated with herniated tissue and disrupted neural tube fusion. The latter disruption occurs around the third week after conception, with the causes remain unclear.

Case Presentation

A 2 years old girl is complaining of a lump at the bottom of the spine since birth without other symptoms. Physical exam of thoracolumbar region found a skin coloured, rubbery consistent, nontender lump of 10x10x8 cm in size. No further abnormalities were found on other physical examination. According to the patient’s mother, there was no family history of a similar disorder. To support the diagnosis, an additional examination CT scan imaging was done.

Conclusion

The first procedure is intended to improve the general condition and to prevent the outbreak of meningomielocele. If broken, close the defect immediately and, if there is hydrocephalus, install a shortcut right away. Surgery will not improve the existing neurological condition. Closure of the broken lumps should be done as early as possible to prevent meningitis and contamination.

Key word: Spina bifida, mielomeningocele

 



Predictor Mortality Outcome of Emergency Re-laparotomy in Dr. Sardjito Hospital Yogyakarta using POSSUM Method.

(Physiological and Operative Severity Score for the enUmeration of Mortality)

 

Uras Indriawan, Imam Sofii, Hendro Wartatmo

Digestive Surgery Sub Division, Department of Surgery Dr. Sardjito Hospital Yogyakarta

 

Abstract

Background

Generalized postoperative peritonitis is one of the complications that often require emergency re- laparotomy  or re-exploration which aims to live-saving.

The purpose of this study to evaluate the indication of emergency re-laparotomy and validate POSSUM score in predicting mortality of emergency re-laparotomy in Dr. Sardjito Hospital Yogyakarta.

Patients and Methods

Cohort-prospektif study, from July 2010 – Desember 2011, 39 patients with diagnosis generalized postoperative peritonitis underwent re-laparotomy at emergency room Dr. Sardjito Hospital Yogyakarta evaluated the indication of emergency re-laparotomy and value POSSUM score in predicting mortality using linier analysis and compared with actual outcomes.

Result

Common indications for carrying out emergency re-laparotomy was generalized postoperative peritonitis caused by leakage anastomosis, hemorrhage, intra abdominal abscess and bowel perforation with mortality rate 46 % (18 cases).

Correlation between POSSUM with mortality emergency re-laparotomy show a valued positive correlation that can prove with significantion = 0.0000 (P=0.000) and strong of correlation = 0.901           ( r = 901 ).

Conclusions

POSSUM method is a good predictor and easily applied to predictive mortality patients with generalized postoperative peritonitis who undergoing emergency re-laparotomy..

Keywords : Mortality, Emergency Re-laparotomy, POSSUM.

 



The Risk Factors of Anastomotic Leakage after Anterior Resection for Rectal Cancer in

Dr. Sardjito Hospital Yogyakarta, 2009 – 2011

 

Uras Indriawan, Hendro Wartatmo, Imam Sofii

Digestive Surgery Sub Division, Department of Surgery Dr. Sardjito Hospital Yogyakarta

 

Abstract

Background

The most important surgical complication following rectal resection with anastomosis is symptomatic anastomotic leakage, especially after resection of middle and low rectal cancers. Anastomotic leakage is also a major cause of postoperative morbidity and mortality in patients with rectal cancer undergoing sphincter preservation surgery particularly anterior or low anterior resection.

The aim of this study was to analyse the risk factors of anastomotic leakage after anterior or low anterior resection at Dr. Sardjito Hospital Yogyakarta.

Patients and Methods

Retrospective data collection from patients with rectal cancer who underwent elective surgical procedures anterior or low anterior resection 2009 – 2011 and determine risk factors associated with anastomotic leakage. The data were analyzed using computer program statistical package SPSS (Statistical Package For The Social Science) version 17.0.

Result
The study included 43 patients, male 51.2 % and female 48.8 % with anastomotic leakage rate 23.6 % and the mortality rate of anastomotic leakage 40 %.

Analysis of the data are statistically significant differences between anastomotic leak with comorbid hypertension (p = 0006), hemoglobin (p = 0.001), albumin (p=0000), location of tumor (p = 0.000) and surgery procedures (p = 0024). There were no statistically significant difference between anastomotic leakage with sex (p = 0535), age (p = 0327), comorbid diabetes mellitus (p = 0188), leucocytes (p = 0197), ASA status (p = 0986 ), Dukes stage (p = 0635) and diversion stoma (p = 0437).

Conclusions
This study was found 5 risk factors associated with anastomosis leakage is comorbid hypertension, hemoglobin, albumin, tumor location and surgery procedures.

Key words: Risk factors for anastomotic leak, Rectal carcinoma, Anterior Resection.

 



Management of Transanal Mucosectomy and Anal Purstring to Rectal Prolapse on Child : a case report

 

 

Yhohan Z. Thaihutu*, Akhmad Makhmudi**

 

 

* Resident of Pediatric Surgery, Medical Faculty of UGM/ Dr Sardjito General Hospital Yogyakarta

** Consultant of Pediatric Surgery, Medical Faculty of UGM/ Dr Sardjito General Hospital Yogyakarta

 

 

 

Abstract

Background

Rectal prolapse is aberration of rectal wall turn out to anal minimally 5 mm. It caused by constipation, diarhea, weakness of pelvic floor, malnutrition, chronic cough and chronic vomiting. There are several surgery procedure to management of rectal prolapse based on underlying disease as caused.

 

Objective

To describe a management to rectal prolapsed on child with transanal mucosectomy and anal purstring.

 

Case Report

It is reported: a boy, 5 years old, came to hospital with chief complain a mass that out from anus about 6 cm since last a week. There is history of constipation since he was 3 years old and there is no history of diarhea and there is no bloody or mucous defecation.

 

Results

We perform transanal mucosectomy and anal purstring procedure with hegar sparkplug number 19th as guidance. Then we set a rectal tube for five days. We got good result and normal defecation.

 

Conclusion

There are several surgery procedure to management of rectal prolapse based on underlying disease as caused. One of them as we done with transanal mucosectomy and anal purstring procedure.

 

Key Words

Rectal prolapse on child, transanal mucosectomy and anal purstring

 


Pancreatic Trauma: a case report

 

Yhohan Z. Thaihutu*, Iswadi**, Imam Sofii***

* Resident of Surgery, Medical Faculty of UGM/ Dr Sardjito General Hospital Yogyakarta

** Trainee of Digestif Surgery,  Medical Faculty of UGM/ Dr Sardjito General Hospital Yogyakarta

*** Consultant of Digestif Surgery, Medical Faculty of UGM/ Dr Sardjito General Hospital Yogyakarta

 

Abstract

Background

Pancreatic trauma is a rare case but its potentially high mortality up to 45%. Reported that Insidency of pancreatic trauma was 1-2 % on patient with blunt trauma and higher on penetrating trauma up to 12 %. Prevalence of pancreatic trauma was 4:1.000.000 that needs hospitalization care and about one-third of them caused by blunt trauma. There is a big number of pancreatic blunt trauma was associated with other intraabdomnal organ blunt trauma and diagnosed after perform eksploratory laparotomy caused by haemodinamic disturbance, posit

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