Highlights Determining the right time to do examination on pregnant patients with persistent gastrointestinal disturbances is still on debate. Gastric cancer should be suspected when epigastric/abdominal pain, nauseous, vomiting happen up to 2nd trimester. Additional examinations with lowest risk effects and optimal accuracy must be done to evaluate resectability. MRI is recommended for staging despite its low accuracy. Contrast abdominal CT scan can be done in pregnancy with consent. Surgery and chemotherapy are relatively safe in 2nd and 3rd trimester for their lower risk of malformation and abortion.

Intestinal amoebiasis is a parasitic infection caused by Entamoeba histolytica. It is commonly found in developing countries with poor hygiene. A rare, life-threatening complication of amoebiasis is fulminant necrotizing amoebic colitis (FulNAC). We report a 59-year-old male with acute lower right abdominal pain. Before coming to our institution, he was diagnosed with acute appendicitis. Extensive necrosis near the caecum involving the appendix and colon was observed intraoperatively. The patient underwent a right hemicolectomy, followed by an ileostomy and colostomy. Histopathologic examination confirmed the diagnosis of FulNAC. After the surgery, the patient was transferred to the high care unit and treated with metronidazole after histopathologic findings confirmed the etiology. The patient showed excellent response to the antibiotic prescribed, and the symptoms subsided. He was discharged from the hospital on day nine. Additionally, we reviewed fifty-one existing case reports on invasive intestinal amoebiasis worldwide, confirmed by histopathological examination following their preoperative diagnosis, surgery, pharmacology treatment, and outcomes. The learning point of this case is that intestinal amoebiasis should be considered a differential diagnosis for patients around fifty years old with bowel symptoms and travel history or living in tight quarters. Blood tests, radiological examinations, and serological evaluations are valuable diagnostic modalities. Metronidazole should be given as early as possible, and health promotion is recommended to prevent this disease in the population.

Introduction. The incidence and mortality of colorectal cancer (CRC) in young adults (below the age of 50 years) has been increased. However, there's no screening method for these cancer in those group of age because there is no scientifically proven risk factor. Thus, a meta-analysis carried out to find out the risk factor for CRC in young adults. Method. A Meta-analysis study was conducted in January 2017. Literature search addressed to the articles published during a period of 2007-2017 in Cochrane and PubMed using keywords: "young" AND "risk factor" AND "colorectal cancer" OR "colon cancer" or "rectal cancer". Inclusion criteria were the CRC prevalence, risk factor analysis for CRC incidence and young population (below 50 years old). The meta-analysis carried out through qualitative and quantitative approach. Results. In the last 10 years, there were twelve published articles met the criteria. Those were cohort study (an article), case-control study (four articles), and cross-sectional study (seven articles). Twenty-five risk factors were noted. The meta-analysis showed that gender (males) with OR = 1.66, 95% CI = (1.04-2.64); I2 = 93%), family history with OR = 2.01, 95% CI = (1.11-3.67); I2 = 78%), metabolic syndrome with OR = 1.80, 95% CI = (1.49-2.16), I2 = 0%), and smoking with OR = 1.57, 95% CI = (1.40-1.77), I2 = 4%) were the significant risk factors with the association of CRC. Conclusion. Young adults of males, with a family history of CRC, metabolic syndrome, and smoking were at the risk to have colorectal cancer.

Latar Belakang: Penegakkan diagnosis apendisitis perforasi sebelum tindakan operasi akan berpengaruh terhadap morbiditas pasien. Dengan anamnesis, pemeriksaan fisik dan pemeriksaan penunjang sederhana berupa peningkatan nilai lekosit, dan netrofil segmen dan peningkatan nilai bilirubin total pre-operatif diharapkan dapat memprediksi diagnosis apendisitis perforasi. Metode: Dari 128 pasien apendisitis akut yang dating ke IGD dilakukan pemeriksaan penunjang tambahan nilai bilirubin total dan dilakukan apendektomi dikumpulkan secara retrospektif dari Januari – Juli 2016. Data dasar karateristik pasien, hasil penunjang laboratorium darah dan laporan operasi diambil dari rekam medik, lalu dilakukan analisis multivariate untuk melihat korelasinya. Hasil: Dari 128 pasien yang didiagnosis awal sebagai apendisitis akut sebanyak 68,8% dan apendisitis perforasi sebanyak 31,3% didapatkan temuan intra operatif apendisitis non perforatif sebanyak 46,9% dan apendisitis perforasi sebanyak 53,1% dengan nilai rata-rata bilirubin total adalah 1,19 mg/dL dan nilai cut off  adalah 1,00 mg/dL. Laki-laki dengan apendisitis perforasi 66,1% dan perempuan 33,9%  .Dengan lama sakit di rumah sebelum dating ke IGD rata-rata 3,5 hari. Dengan nilai sensitivitas 77,94%; spesifitas 76,67%, nilai prediktif positif 79,1% dan nilai prediksi negative 75,41%. Pada uji analisis multivariate didapat kan nilai bilirubin total ( odds ratio 5,016; 95% confidence interval 2,092-12,026; P = < 0,0001), leukosit ( odds ratio 1,993; 95% confidence interval 0,893-4,451; P = 0,092) dan alvarado score ( odds ratio 3,193; 95% confidence interval 1,542-6,611; P = 0,002) yang secara statistic signifikan untuk memprediksi diagnosis apendisitis perforasi pre-operatif. Simpulan: Hiperbilirubinemia secara satitistik signifikan untuk memprediksi diagnosis apendisitis perforasi pre-operatif.

Introduction: Non-parasitic liver cyst are seen in up to 5% of the population. They become symptomatic when the are large and can cause pain, nausea, vomiting, early satiety and obstructive jaundive. Treatmen modalities include percutaeneous drainage, open deroofing, hepatic resection, amd lately, laparoscopic deroofing liver cyst. We sought to evaluate the feasibility and outcomes of management of symptomatic liver cysts and surgical success, focusing on cyst recurrence. Method: From January 2016 to March 2019, 18 consecutive patients with symptomatic liver cysts were evaluated and treated at Cipto Mangunkusumo Hospital retrospectively discuss. Result: The median patient age was 54 (28-69 ) years, with a median lesion diameter of 6,5 cm. The cyst were simple cysts (n = 13), multiple cysts (n = 5). Fifteen patients had American Society of Anesthesiologists (ASA) classification II, and one had ASA classification I, III and IV. Surgical treatment of liver cysts were laparoscopic deroofing (n = 16) and laparotomy deroofing (n=2). The median followup was 22 weeks, and 2 patients (%) experienced radiographic-apparent recurrence. Reoperation due to recurrence was performed in one patients. Conclusion: Management of liver cysts with deroofing cyst is a simple and effective method to relieve symptoms with minimal recurrencce

Introduction: Insulinoma is MEN-1 are multifocal with no site predilection. Current guidelines do not favour particular surgical approach. Consequently, its anatomical location or individual centers experience which guides enucleation, partial or total pancreatectomy. Method: We encountered four patients of Insulinoma in MEN-1 from July 2017 to June 2018. Clinical symptoms, biochemical investigation and CECT abdomen was performed to clinch the diagnosis. MRCP was performed to determine its relation with main pancreatic duct and 68-Ga DOTANOC PET-CT was done to delineate other endocrine lesions. Enucleation was performed in all 4 patients with utilization of intra-operative continuous glucose monitoring (CGM) to ascertain removal of dominant lesion. An upward CGM spike was used to define excision of dominant lesion and confirmed in all patients. Demographics, pre-operative investigations, peri-operative parameters and outcomes of patients were reviewed. Result: All patients were female with median age was 36 years (range 28-45). The median serum Insulin and C-

Introduction. Nowadays, tuberculosis remains an issue of global. It may have affected all gastrointestinal organs, including peritoneum. Thus, diagnostic approach of this abdominal tuberculosis remains challenging as it may present non-specific features and mimics other abdominal pathologies. A study focused on clinical and laboratory findings, imaging and evaluation of management of those diagnosed as abdominal tuberculosis was required. Method. A cross-sectional study proceeded retrospectively aimed for an evaluation. All abdominal tuberculosis managed in dr Cipto Mangunkusumo General Hospital, Jakarta and Fatmawati General Hospital, Jakarta during January 2011 to December 2013 were enrolled. Data collected from data registration, subject's characteristic, clinical findings, laboratory findings, and imaging were variables subjected to analysis. Results. There were forty-eight subjects recorded. The most symptoms found were abdominal pain (81.25%), abdominal distention (72.9%), fever (68.75%) and weight loss (68.75%). While as most laboratory findings were leukocytosis (52%) and elevated erythrocyte sedimentation rate, ESR (72.9%). And up to 50% subject showed normal chest x-ray while as other showed non-specific features for pulmonary tuberculosis. Conclusion. Clinical presentations showed to be diverse. Laboratory finding, and imaging maybe valuable to diagnose abdominal tuberculosis, although chest x-ray represents non-specific features for pulmonary tuberculosis. Evaluation of these clinical findings and lead to accurate diagnostic approach; which was determine the characteristics associated with abdominal tuberculosis diagnostics value..

BACKGROUND The pathogenesis of intestinal fibrosis after strangulation in abdominal surgery is not fully understood. Developing an experimental and reliable method is needed to overcome this problem. This study aimed to develop an effective method for intestinal strangulation leading to fibrosis, which might induce intestinal obstruction. METHODS This study was conducted from 2018 to 2019 at the Department of Pharmacology, Faculty of Medicine, Universitas Indonesia. A total of 24 Sprague Dawley rats were used in this study. Artificial intestinal strangulation using cable ties made of durable plastic, which is generally used to ligate objects, was applied, and rats were further classified into control, 6-hour, and 24-hour strangulation groups. At the end of the study, the rats were sacrificed, intestinal tissues were collected, and histomorphological changes were observed using hematoxylin and eosin stain. Moreover, Masson’s trichome staining was used to assess collagen density. RESULTS Median collagen density score of the 24-hour strangulation group was higher than the control. A significant difference in collagen density was found between the submucosal layer of the 24-hour strangulation group and the control (45.4 [11.4] versus 32.4 [14.0], p<0.001) and between the mucosa of the 6- and 24-hour strangulation groups and the control (26.9 [17] versus 6.46 [4.3], p = 0.01 and 24.9 [8] versus 6.46 [4.3], p = 0.004, respectively). CONCLUSIONS The simple use of cable ties adequately promotes intestinal strangulation.