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All Journal Syntax Literate: Jurnal Ilmiah Indonesia Journal of Comprehensive Science
Indrayani, Made
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Humanities Computer Science & IT Economics, Econometrics & Finance Education Electrical & Electronics Engineering Environmental Science Languange, Linguistic, Communication & Media Law, Crime, Criminology & Criminal Justice Library & Information Science Social Sciences Other

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Perdarahan Saluran Cerna Atas Pascaoperasi Whipple Dengan Komplikasi Fistula Pankretokutan: Komplikasi Langka Dan Peran Oktreotid Sebagai Terapi Efektif Indrayani, Made; Andari Kluniari , Ni Made Nova
Journal of Comprehensive Science Vol. 4 No. 9 (2025): Journal of Comprehensive Science
Publisher : Green Publisher Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.59188/jcs.v4i9.3565

Abstract

Whipple's postoperative gastrointestinal bleeding is a rare but fatal complication. Diagnosis and management of Whipple's postoperative slow-type bleeding with complications of pancretocutaneous fistula is often challenging due to atypical clinical manifestations and complex postoperative anatomy. Case Report: A 28-year-old male patient came in with black chapters, abdominal pain, nausea and vomiting since 2 weeks earlier. The patient underwent Whipple surgery 6 years ago with complications of pancreatocutaneous fistula. Despite having undergone fistula closure surgery 3 years ago, the fistula reopened and produced a clear, yellowish fluid. Patients exhibit conditions of hemodynamic instability, clinical dehydration and anemia. Computed tomography (CT)-scan showed the presence of necrotic pancreatitis. Despite receiving blood transfusions and supportive therapy, the patient still experiences black chapters and hemoglobin levels continue to decline. The patient then received additional therapy with intravenous octreotides where the patient showed clinically significant improvement characterized by cessation of black chapters and decreased fistula production. Conclusion: Gastrointestinal bleeding is one of the complications that can occur years after Whipple's surgery. These complications are often associated with the formation of pancreatic fistulas that cause vascular erosion, pseudoaneurysm formation, and prolonged inflammation. Therefore, in these cases, octreotides can be considered as an adjuvant therapy that not only helps to stop bleeding, but can also help decrease the secretion of pancreatic fluid and the closure of the fistula.
Pit Viper Venom-Induced Coagulopathy: Mandatory Antivenom, Avoidance of Anticoagulants, and Selective Transfusion Indrayani, Made; Andriyasa, I Ketut; Nugraha, Putu Arya; Widiastika, Made; Kluniari, Ni Made Nova Andari
Syntax Literate Jurnal Ilmiah Indonesia
Publisher : Syntax Corporation

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.36418/syntax-literate.v10i12.62728

Abstract

Venom-induced consumption coagulopathy (VICC) is a life-threatening complication following pit viper bites and remains a significant health concern in Southeast Asia. VICC has a distinct pathophysiology compared to typical disseminated intravascular coagulation (DIC), requiring a tailored management approach. This case highlights the successful treatment of severe VICC following a red-tailed green viper bite. A 64-year-old woman presented with left hand swelling three days after a red-tailed green viper bite to the wrist. She also had vomiting and fever on first day. She was alert and hemodynamically stable. Laboratory tests revealed severe thrombocytopenia (50 x 10³/μL), markedly elevated D-dimer (>10,000 ng/mL), and prolonged coagulation times. Complications included acute kidney injury, elevated liver enzymes, and gross hematuria. She received an initial dose of 2 vials of antivenom with close monitoring. As her coagulopathy progressed, additional antivenom was administered every 8 hours. Her condition began improving on day five without requiring blood transfusion. Unlike typical DIC, VICC should be managed primarily with antivenom, which neutralizes circulating venom and halts further coagulopathy. Anticoagulants are contraindicated, as pit viper venom contains both procoagulant and anticoagulant components that can worsen bleeding. The use of blood products in VICC is selective and symptom-based. Fresh frozen plasma (FFP) may be considered in patients with active bleeding or severe coagulopathy, thrombocyte concentrate (TC) is indicated if thrombocytopenia persists despite adequate antivenom, and packed red cells (PRC) are reserved for life-threatening anemia. VICC is a distinct coagulopathy requiring prompt antivenom administration, careful avoidance of anticoagulants, and judicious use of transfusions.
Co-Authors Andari Kluniari , Ni Made Nova Andriyasa, I Ketut Kluniari, Ni Made Nova Andari Nugraha, Putu Arya Widiastika, Made