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All Journal Medicina ISM (Intisari Sains Medis) : Jurnal Kedokteran Neurologico Spinale Medico Chirurgico
Ketut Sudiasa
Department Of General Surgery, Trauma Surgery Division, Faculty Of Medicine, Udayana University, Sanglah General Hospital, Denpasar, Bali, Indonesia
Biochemistry, Genetics & Molecular Biology Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience

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Penanganan pseudokista pankreas karena trauma Margareth, Sessy Arie; Wiargitha, I Ketut; Sudiasa, I Ketut
Medicina Vol 47 No 1 (2016): Januari 2016
Publisher : Medicina

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (669.995 KB)

Abstract

Kista pankreas karena trauma adalah kasus yang jarang terjadi dengan angka kejadian 5% pada kasus trauma. Gejala kista pankreas muncul tiga minggu pasca-trauma sehingga sering terjadi keterlambatan penanganan. Lebih dari 75% kista pankreas merupakan kista semu (pseudokista), dindingnya tidak dibatasi oleh epitel, melainkan jaringan ikat. Diagnosis kista pankreas ditegakkan melalui anamnesis, pemeriksaan kadar amilase, ultrasonografi (USG) abdomen, dan computed tomography (CT) scan abdomen. Penanganan konservatif dilakukan bila kista dapat beresolusi sendiri. Operasi eksisi atau drainase interna dilakukan pada kista yang kecil. Kista yang besar ditatalaksana dengan sistogastrostomi, sistojejunostomi, atau sistoduodenostomi. Drainase eksternal dilakukan bila kista ruptur atau terinfeksi. Anak lelaki usia 9 tahun datang dengan keluhan utama nyeri perut kiri atas yang menjalar ke punggung dan menetap. Hal ini terjadi setelah penderita mengalami trauma pada perut. Pada pemeriksaan fisis didapatkan perut distensi, teraba masa lunak, dan mobile pada epigastrium. Pemeriksaan laboratorium menunjukkan peningkatan kadar amilase serum. Pemeriksaan USG dan CT scan menunjukkan gambaran kista pankreas. Pada saat operasi didapatkan kista pankreas di daerah kauda pankreas dan dilakukan sistojejunostomi. Lima hari pasca-operasi penderita pulang tanpa komplikasi. Evaluasi 6 bulan pasca-operasi, penderita tampak membaik dengan kadar amilase normal. Pancreatic cyst is a rare case. The incidence rate is 5% on trauma case. The symptom persist three weeks after trauma, causing delayed management. More than 75% pancreatic cysts are pseudocysts, where the wall is not confined by epithelial cells but by connective tissue. Diagnosis can be established by history taking, amylase examination, abdominal ultrasonography, and computed tomography scan of abdomen. The management is conservative if the cyst resolutioned by itself. Cystic excision or internal drainage was done if the cyst is small. Big cysts usually treated with cystogastrostomy, cystojejunostomy, or cystoduodenostomy. External drainage was done if the cyst ruptured or infected. A 9-year-old male with chief complaint pain on the upper left abdominal area that spread to the back and persistent, occurred three weeks after abdominal trauma. On abdominal physical examination, there was abdominal distension and palpable mobile mass on epigastrium. Laboratory examination showed increased of serum amylase. Abdominal USG and CT scan showed pseudocyst pancreas. During surgery, pancreatic cysts on caudal of the pancreas was found, and cystojejunostomy was done. There was no complication five days after the operation. Six months follow up after the surgery, patient is getting better with normal serum amylase.
Validity of predictive score of mortality in peptic ulcer perforation (POMPP) in predicting perforated peptic ulcer mortality operated in Sanglah General Hospital, Denpasar, Bali I Gusti Putu Agung Pratama Putra; Ketut Sudiasa; Tjokorda Gde Bagus Mahadewa
Neurologico Spinale Medico Chirurgico Vol 5 No 1 (2022)
Publisher : Indoscholar

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.36444/nsmc.v5i1.210

Abstract

Introduction: Peptic ulcer perforation is a non-traumatic emergency that is often encountered and gives a mortality rate of up to 70%. The need for a system that is easy and simple in predicting and screening patients in the initial triage to predict the incidence of mortality after surgery is important. This study aim to test the validity of predictive score of mortality in peptic ulcer perforation (POMPP) in predicting mortality in patients with perforated peptic ulcer surgery. Methods: This study was a diagnostic study with 50 peptic ulcer perforation patients operated between February 2019 to February 2020, and collected with consecutive sampling method. All patients who were operated was calculated for the preoperative POMPP scores, with parameters of age, blood urea nitrogen, and albumin. Patients who were deceased or refused to participate were excluded. The best cut-off point was calculated, then sensitivity, specificity, positive and negative predictive value (PPV/NPV), accuracy of score and POMPP score validity were calculated in predicting post-operative patient mortality. Results: The best cut-off value obtained from receiver operating characteristic (ROC) curve was ≥1.5, where patients with POMPP ≥1 were exposed to a high risk of postoperative mortality (80.8%), and POMPP <1.5 had a low risk of postoperative mortality (19.2%). Other scores were calculated as follow: sensitivity 80.7%, specificity 91.6%, PPV 91.3%, NPV 81.4%, accuracy 86% and the validity test score of 50 patients reached 100%. Conclusion: POMPP has good validity and can be used as a screening tool for patients with perforated peptic ulcer surgery.
Faktor-faktor yang berhubungan dengan terjadinya hipertensi intraabdominal pada pasien dengan peritonitis di RSUP Sanglah Denpasar dari bulan Januari 2017 - Desember 2018 Krishna Kurnia Pratama; Ketut Sudiasa; Nyoman Golden
Intisari Sains Medis Vol. 11 No. 2 (2020): (Available online: 1 August 2020)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (367.595 KB) | DOI: 10.15562/ism.v11i2.723

Abstract

Background and aim: Peritonitis is an emergency condition in the field of surgery due to its several complications. The most challenging is intraabdominal hypertension which can develop into abdominal compartment syndrome. There are several factors that cause intraabdominal hypertension in patients with peritonitis. This study aims to found factors that are associated with the occurrence of intraabdominal hypertension in peritonitis patients at Sanglah General Hospital in January 2017-December 2018.Method: This research used cross sectional analitic with total sampling technique with 136 peritonitis patients in Sanglah Hospital from Januari 2017 until December 2018 as respondents. Data source obtained from medical report. Bivariat analysis done to find factors related with intraabdominal hypertension in peritonitis patients with chi square method and multivariate analysis with logistic regression.Result: The majority of respondents are male, aged 15-64 years, organs involved in peritonitis in the form of solid organs, peritonitis that occurs through trauma mechanisms, experiencing sepsis, leukocytosis, and not hypoalbumin. Three variables were found to be significantly related they are, peritonitis caused by hollow organ perforation, sepsis condition, and hypoalbumin conditions. Only the sepsis condition has significant relationship with the occurrence of intraabdominal hypertension. Sepsis is 0.262 times more likely to cause intraabdominal hypertension in patients with peritonitis compared to patients without sepsis.Suggestion: Closely monitoring intraabdominal pressure should be carried out, especially in patients with sepsis, hypoalbumin, and those suspected of having perforations in hollow organs and further research is needed with a larger number of samples and more superior research methods. Latar belakang dan tujuan: Peritonitis merupakan kondisi kegawatdaruratan di bidang bedah karena dapat menyebabkan terjadinya beberapa komplikasi salah satu yang terberat adalah hipertensi intraabdominal yang dapat berkembang menjadi sindrom kompartemen abdomen. Terdapat beberapa faktor yang menyebabkan hipertensi intraabdominal pada pasien peritonitis. Penelitian ini bertujuan untuk melihat faktor-faktor yang berhubungan dengan terjadinya hipertensi intraabdominal pada pasien peritonitis di RSUP Sanglah bulan Januari 2017-Desember 2018.Metode: Penelitian analitik cross sectional dilakukan menggunakan teknik total sampling dengan melibatkan 136 responden yang merupakan pasien peritonitis yang dirawat di RSUP Sanglah bulan Januari 2017-Desember 2018. Sumber data berupa rekam medis pasien. Analisis dilakukan untuk melihat faktor yang berhubungan dengan hipertensi intraabdominal pada pasien peritonitis secara bivariat dengan metode chi square dan multivariat dengan regresi logistik.Hasil: Mayoritas responden berjenis kelamin laki-laki, berusia 15-64 tahun, organ terlibat dalam peritonitis berupa organ padat, peritonitis yang terjadi melalui mekanisme trauma, mengalami sepsis, leukositosis, dan tidak hipoalbumin. Tiga variabel ditemukan signifikan berhubungan yakni peritonitis diakibatkan oleh perforasi organ berongga, kondisi sepsis, dan kondisi hipoalbumin. Hanya kondisi sepsis yang memiliki hubungan murni dengan terjadinya hipertensi intraabdominal. Kondisi sepsis berisiko 0,262 kali lebih besar menyebabkan terjadinya hipertensi intraabdominal pada pasien peritonitis dibandingkan dengan pasien yang tidak mengalami sepsis.Saran: Sebaiknya dilakukan pemantauan tekanan intraabdominal secara ketat, terutama pada pasien dengan sepsis, hipoalbumin, dan yang dicurigai mengalami perforasi pada organ berongga serta diperlukan penelitian lanjutan dengan jumlah sampel yang lebih besar serta metode penelitian yang lebih superior. 
Co-Authors I Gusti Putu Agung Pratama Putra I Ketut Wiargitha Krishna Kurnia Pratama Nyoman Golden Sessy Arie Margareth, Sessy Arie Tjokorda Gde Bagus Mahadewa