The patient presented with inability to defecate for 7 days, abdominal pain, fever, vomiting, weight loss, and cough with green sputum for a month. On examination, the patient had a fever, abdominal distension and tenderness, increased bowel sounds, and tight anal sphincter tone with collapsed rectal ampulla. Laboratory findings were notable for anemia. The working diagnosis was partial mechanical bowel obstruction possibly due to peritoneal tuberculosis based on the history and physical exam. The patient received NG tube decompression, IV fluids, antibiotics, analgesics, and was planned for CT scan of the abdomen.

1. AT/M/19yo

2. Chief Complaint : Can not defecate
It has been suffered since 7 days before admitted to
hospital. He also complained of intermittent
abdominal pain. Flatus (+). Patient had fever since
one week before. Vomiting more than 5 times a
day. History of weight loss (+). Cough since a month
ago, with greenish sputum without blood. History
of night sweat (+). Micturition (+) normal. History of
tuberculosis in the family was denied.

3. Present State :
Awareness : Alert
Blood pressure : 110/70 mmHg
HR : 98 x/i
RR : 24 X/i
Temp : 38,60C

4. Generalized State
Head and neck : conj palp inf pale (-)
Thorax : I : simetric
P : SF equal on both hemithorax
P : sonor on both of hemithorax
A : Sound of breath : vesicular on both of hemithorax
Abdomen : Localized state
Genitalia : male, no abnormality
Extremity : no abnormality

5. Localized state:
Abdomen:
I : Symmetry, distention (+), visible bowel movement (+)
P: Tenderness (+)
P: Hypertympani
A: peristaltic (+) increase
DRE: perineum usual, tight tonus anal sphincter, pain (-), smooth
mucosa, ampulla recti was collaps. Hand gloves : Feces (+), blood
(-), mucous (-)

7. Laboratorium finding:
Hb / Hct / WBC / PLT : 13,3/41,7/9,1/331
Na / K / Cl : 145/3,9/104
Albumin : 3,1
Random Blood Sugar Level : 116,0
Ur/Cr : 108,45/2,37

8. Chest X-ray

11. Working Diagnosis :
Partial Mechanical Bowel Obstruction d/t Susp.
Peritoneal TB

12. Management in Emergency Room:
• Nil per mouth
• Insertion NGT,comeout clear fluid about 100 cc
• Insertion urine cateter,came out initial urine
output about 110 cc,clear yellow colour
• IVFD Crystalloid
• Inj. Antibiotics
• Inj.Analgetic
• Conservative
• Plan : CT Scan Abdomen