Ileus Obstruksi Parsial akibat Intususepsi Ileocaecal dan Tumor Colon Ascendens pada Pasien Perempuan Dewasa

2025-03-25T09:06:12+00:00

Introduction: Intussusception is a rare condition in adults. It can cause ischemic necrosis, perforation, and peritonitis. Objective: This case report highlights the clinical presentation, diagnosis, and management of bowel obstruction due to intussusception in an adult. Case Illustration: A 43-year-old female patient presented with watery stools mixed with blackish blood, abdominal pain, vomiting, and decreased appetite. Abdominal examination revealed mild distension, reduced bowel sounds, generalized tenderness, and a firm, mobile mass (10 × 10 × 5 cm) in the right lower quadrant. Digital rectal examination showed a dilated rectal ampulla, extra luminal protrusion, and blackish blood-stained feces. Imaging studies confirmed a high-level obstruction and ileocecal intussusception with bowel wall edema. The patient was diagnosed with partial bowel obstruction. Discussion: This unusual case involves a localized tumor in the ascending colon acting as a lead point, leading to ischemia and mucosal necrosis. Accurate diagnosis in adults relies on timely imaging examinations. While plain radiography (BNO) may show signs of intestinal obstruction, its sensitivity is limited. Initial management focuses on stabilizing the patient’s condition by using a gastric tube for decompression, providing intravenous fluids for rehydration, administering analgesics and antibiotics, and, if appropriate, performing a barium or air enema to help reposition the affected segment. Prompt management is essential to prevent serious complications. Conclusion: Adult intussusception is rare and requires diagnosis through history, physical examination, and radiologic studies. Management involves initial medical stabilization and surgical intervention.

Antibiotic Therapy Evaluation of Patients Diagnosed with Sepsis in ICU of dr. Mohamad Soewandhie General Hospital based on the Gyssens Method

2025-01-30T06:05:40+00:00

ABSTRACT

In the high-stakes world of Intensive Care Units (ICUs), the judicious application of empirical antibiotic therapy is crucial for managing sepsis in critically ill patients, as its misuse is often linked with unfavorable patient outcomes. Thus, timely and precise treatment strategies are indispensable. This study was designed to evaluate the rationality of such treatments among sepsis patients at RSUD Dr. Mohamad Soewandhie between January 2021 and September 2024. Using an observational and descriptive approach, researchers scrutinized secondary data from 120 patient medical records, with expert reviewers employing the Gyssens method to assess treatment rationality. Findings revealed that 60% of patients received appropriate empirical antibiotic therapy, most commonly intravenous Ceftriaxone. Alarmingly, culture and antibiotic sensitivity tests were conducted on only 18 patients, yielding 11 positive results, and among these were 19 gram-negative and 2 gram-positive bacterial isolates, with a troubling 67.9% being multidrug-resistant organisms (MDRO). Despite the empirical therapy's rationality, the study noted a concerning mortality rate of 81.67%, possibly owing to delays in obtaining culture results and the use of outdated local guidelines for antibiotic therapy in sepsis management, highlighting gaps in existing approaches.

Keywords:Empirical Antibiotic Therapy, Intensive Care Unit, Sepsis, Septic Shock, Gyssens Method

Jurnal Kedokteran Meditek

Ileus Obstruksi Parsial akibat Intususepsi Ileocaecal dan Tumor Colon Ascendens pada Pasien Perempuan Dewasa

Antibiotic Therapy Evaluation of Patients Diagnosed with Sepsis in ICU of dr. Mohamad Soewandhie General Hospital based on the Gyssens Method