presented as an internship at lasinrang hospital, pinrang

1. HERNIAINGUINALISLATERALIS
A CASE REPORT OF
PRESENTED BY
Dr. M. Ikhlas Yakin
Lasinrang Hospital, Pinrang

2. PATIENTIDENTITY
• Mr. A
• 31-12-64 (52 Y.O)
• MR 128***
• Farmer
• Examination Date ; 11
- 9 -2017

3. ANAMNESIS
Chief
complaint
lump in
the left
iliac
region
through
the groin
Since ± 3
years ago
Reponibl
e
Enlarge
when
cough or
lifting
heavy
object
pain (-)
Hiperemi
s (-)
Digestive
problem (-
)
History
of
another
disease
(-)

4. PHYSICAL EXAMINATION
General Condition:
Well nourished/Compos mentis
Vital Sign
Blood Pressure : 120/80mmHg
Pulse : 88 bpm
Breathing : 20 x/min
Temp : 36,5oC

5. GeneralExamination
HEAD
• Conjungtiva ; anemic (-) Sclera ; icteric (-)
• Nose ; Oedema of the concha (-) , Ear ; Otorrhea (-) Tophy (-) , Lips ;
Cyanotic(-)
THORAX
•Inspection ; Symmetrical, Breathing movement (+)
•Palpation; Pain (-) , Mass (-), Crepitation (-)
•Percussion ; Sonor
•Auscultation; Vesiculer, Ronkhi(-) Wheezing (-)
ABDOMEN
•Inspection : Flat
•Auscultation : peristaltic (+)
•Percussion : tympani
•Palpation : pain (-), hepar/lien not palpable
EXTREMITY
• Limb : warm, parese (-), hipestesia (-)
• Oedema : (-) , pitting oedem (-)
COR
• Inspection ; ictus cordis (-)
• Palpation ; ictus cordis (-)
• Percussion ; Dull
• Auscultation ; HS1&2 reguler

6. LOCAL SIGN
Mass 10x4
cm, mobile
Pain (-)
Hiperemis (-)
Transiluminasi
(-)
Reponible
Thumb test ;
no lump
appeared
REGIO INGUINALIS SINISTRA

7. LABORATORIUM
Type Result Normal Limit
WBC 9,6 X 103/mm3 (4,0-10,0x103/mm3)
HGB 15,0 gr/dl (13,0-17,0 gr/dL)
HCT 42,6% (40-54%)
PLT 306x103/mm3 (150-500x103/mm3)
UREUM 27,7 mg/dL (15,0-43,2 mg/dl)
CREATININ 1,02 mg/dL (0,8-1,30 mg/dl)
SGOT 25,4 u/L (0,0-37,0 u/L)
SGPT 17,6 u/L (0,0-41,0 u/L)
GDS 156 mg/dL (74-106 mg/dl)

8. THORAX PA
• 11 – 09 - 2017
• cor: normal, aorta: dilatation
• difragma normal
• Intact bones

9. ANAMNESIS PEMFIS LAB
HERNIA INGUINALIS
LATERALIS REPONIBLE
SINISTRA
DIAGNOSI
S
MANAGEMEN
T
RESUME
HERNIORRAPHY

10. DISCUSSION

11. HERNIA ?
1. Protrution or lump of the
cavity that passed through
the defect of the organ. (1)
2. Protrution of the
abdominal cavity through
the defect of the fascia or
musculoaponeurotic of
the abdominal wall,
congenitally or as a result
of many risk factors (2)
3. Consist of Ring, Pocket
and organ(1)
1. Buku ajar bedah, sjamsuhidajat, de jong
2. Kapita selekta kedokteran FKUI. 2016

12. Hernia
WHEN
Congenital
perfect
Not perfect
Acquisita
clinically
Reponibilis
Irreponibilis
Strangulata
Inkaserata
Direction
Interna
eksterna
CLASSIFICATION

13. EPIDEMIOLOGI
75%
8%
10%
3% 4%
Hernia
Inguinalis Femoralis Incisional
Umbilikus other
1. Sjamsuhidayat. 2010
2. Rasjad C. 2010
0%
20%
40%
60%
80%
100%
MALEFEMALE
97%
50%
2%
34%
1%
16%
Inguinalis Femoralis Lain-Lain

14. ETIOLOGY
• Opening of the processus vaginalis
• Increasing of the intraabdominal pressure
• Age
• Diet

15. DIRECT VS INDIRECT

16. ANAMNESIS
• Lump Consistency?
• Retractable?
• Inflammation sign?
• Problem of the
passage?
• Pain

17. PHYSICAL EXAMINATION
Finger test Ziemen test
Thumb test

18. Hernia exam – dr. khaleed milad , www.youtube.com

19. INCARSERATA vs STRANGULATA
Gejala/tanda Obstruksi usus pada hernia inkarserata Nekrosis/gangren pada hernia strangulata
Nyeri Kolik Menetap
Suhu badan Normal Normal/meninggi
Denyut nadi Normal/meninggi Meninggi/tinggi sekali
Leukosit Normal Leukositosis
Rangsang peritoneum Tidak ada Jelas
Sakit Sedang/berat Berat sekali/toksik

20. MANAGEMENt
• Reposition • Belt

21. OPERATIF
Indikasi :
• Hernia Inkaserata / Strangulasi (cito)
• Hernia Irreponabilis ( urgen, 2 x 24 jam)
• Hernia Reponabilis (elektif)
• Hernia Reponabilis incarserasi (HIL,Femoralis)
Herniotomy : releasing of hernia pocket until the neck
Hernioplasty : reducing size of annulus inguinalis internus
& strengthen the posterior wall of canalis inguinalis
Hernioraphy : herniotomy+hernioplasty

22. PROGNOSIS
• Bonam