Name Age Adress MR No Date

: Nelayeni : 24 yo : Psbn Kalumbuk : 18 61 81 : November 6t 2!!2

Anamnesis A 24 "ears old #atient $as admitted to t e Delivery Room %mergen&y unit o' Dr( M( D)amil *entral +eneral ,os#ital on November 6t at 16 -! $it & ie' &om#lain #ain at rig t in'erior o' t e abdomen
Present Illness History :

Pain at rig t in'erior o' abdomen iregurarly sin&e 24 ours ago( .$o days ago t e #atient 'elt t e same &om#lain /ever $as absent0 'luor $as absent ,istory o' trauma $as absent De'e&ation and mi&tion $as normal Menstruation ,istory : menar& e at 14 years old0 regular &y&le0 every 28 days $ i& last 'or 1 to 2 days ea& &y&le $it t e amount o' 23- times #ad & ange 4day menstrual #ain $as #resent(

Previous illness history No im#ortan&e Family illness history No im#ortan&e Physical Examination +eneral a##earan&e *ons&iousnes 5lood #ressure Pulse Rate Res#iration rate .em#erature : Moderate : /ully &ons&ious and &oo#erative : 11!46! mm,g : 8!64m : 2!64m : -2*

%yes Ne&k * est Abdoment

: *on)un&tiva not anemi& 0 7&lera not i&teri& : 89P 132 &m ,2: 0 .yroid not enlarge : ,4; Normal : +R

+enitalia %6tremity

: +R : %dema 343 0 P ysiologi&al Re'le6 <4< 0 Pat ologi&al Re'le6 343

Gynecologic Record /a&e 5reast Abdomen ?ns#e&tion Pal#ation : . e #regnan&y sign $as =3> : . e #regnan&y sign $as =3> : : Not %nlarged : .umor mass $as #al#able at rig t y#o& &ondrium 7i@e a&oordan&e to and adult 'ist 1 6 4 6 4 &m0 smoot sur'a&e 0 elasti& &onsisten&y0 mus&ular de'ense =3>0 #resure #ain =<>0 release #ain =3> : Dullness at tumor mass

Per&usion

Aus&ultation : #eristalti& sound =<> normal +enitalia ? : :9ulva4Aret ra normal : tumor =3> : MP 7i@e eBual to and adult 'oot toe0 #osterior0 :A% *losed0 s aky #ain =<> : &anCt be evaluated : &anCt be evaluated : Pressure #ain =<>0 #rotruded

5imanual4 9. : 9agina Portio tumor =3> *A. AP *D

R. : Anus normal0 s# in&ter in good &ondition0 mu&ose smoot 0 am#ular em#ty0 .umor =3> Laboratory ,b : 602 gr D ;euko&yte : 261!! *. : 4C-!E 5. : 2C-!E .rombo&yte : 266( !!! Plano test : =<> WD4 A&ute abdomen e& disturbing e&to#i& #regnan&y < graves anemia

Attitude

Fards #re o# Pre#ared ;a#arotomy Pre#ared blood 11!! && *ontrole 970 PP9 *onsult :#eration Room0 Anastesi Plan ;a#arotomy ;a#arotomy begin at !4 11 am ;a#arotomy $as #er'ormed( A'ter t e #eritoneum $as o#ened t ere $as blood and blood &lot 'illed t e abdomen &avity0 %va&uated blood 'rom it 11!! &&0 %6#loration $as #er'ormed0 Aterus as big as du&k egg( ;e't .uba and ovarian s a#e and si@e $as normal /ound ru#tured at Rig t .uba #ars ist mi&a ?m#resion Plan : Ru#tured o' rig t tuba #ars ?st mi&a

: Rig t 7al#inge&tomy

Diagnosed: Post Rig t 7al#inge&tomy on indi&ation Ru#ture rig t tuba #ars ist mi&a