A 31-year-old female presented with abdominal pain that began 1 day prior and had spread to her whole abdomen, along with nausea, vomiting, and abdominal tenderness. Laboratory results and imaging showed signs of diffuse peritonitis suspected to be from a perforated appendix. The patient underwent an appendectomy where 500cc of fluid was found and evacuated from the abdomen. An ovarian cyst was also found and drained. Post-operatively, drains were left in place to evacuate further fluid from the abdomen.

1. S/F/31yo

2. S/F/31yo

3. Chief complaint: Pain on the whole abdomen
The pain has been suffered by the patient since 1 days
before admission to Haji Adam Malik Hospital. Firstly,
pain was feel in epigastrium and spread into whole
abdomen. Fever (-), nausea (+), vomiting (+).
Micturation (+), defecation (-), flatus (+).

4. Present state :
•Awareness : Alert
•BP : 110/80 mmHg
•HR : 85x/i
•RR : 22x/i
•T : 36,8°C
•VAS : 5

5. Generalized State :
• Head and neck : no abnormality was found
• Chest : no abnormality was found
• Abdomen : in localized state
• Genitalia : male, no abnormality was found
• Extremities : no abnormality was found

6. Localized State :
• Abdomen :
I : Symmetry, Distention (+)
P : pain on the whole abdomen, muscular rigidity
(+)
P : tympani
A : Peristaltic decrese
• DRE : Perineum usual, loose anal sphincter tone,
ampulla was not filled faeces, smooth mucous,
pain (-). Hand gloves : feces (-), blood (-), mucous
(+).

8. Laboratory findings:
• Hb/Hct/WBC/PLT : 13,7/41,7/15,1/281
• Na/K/Cl : 130/3,4/104
• Ur/Cr : 15,1/0,61
• Random Blood Glucose :132,3
• Albumin : 3,1

9. Chest X-ray

12. Working Diagnose:
• Diffuse Peritonitis d/t susp. Appendicitis
perforation

13. Treatment
• Nill Per Mouth
• NGT insertion, came out greenish fluid 50cc
• Urine catheter insertion, came out initial clear
yellow urine 100cc
• IVFD Crystalloid
• Antibiotic Injection
• Analgetic injection
• Patient was prepared for appendictomy
laparotomy

16. Cranial

17. In Operating theater
• Patient in supine position in General anasthesia ETT, aseptic, antiseptic procedure
• Midline incision, Cutis, subcutis, fascia, peritoneum was opened came out serous
haemorrhage about 500 cc
• Identification of hollow organ, gaster, jejenum, ileum in normal limit
• Appendix, colon, and sigmoid in normal limit
• Identification pancreas, found expand pancreas, sofonifikasi was found,
necroticans pancreas was not found
• Fluid came from retroperitoneal
• Identification gynecology organ, found ovarium cyst size 5 cm  consult at
durante to Obgyn department  drealing was performed
• Bleeding control
• Abdomen fluid was evacuate intermittenly, leaving 2 drain for external draining
• The surgical wound was closed layer by layer
• Operation was done