Aim: To determine the validity (sensitivity, specificity, likelihood ratio) of barium enema as Hirschsprung's disease diagnostic tool in infants. Methods: This study was a diagnostic test of barium enema compared with postoperative histopathology examinations as the gold standard. The population were all patients with indigestion symptom be discovered at the pediatric surgical clinic of Sanglah Hospital Denpasar. The sampling method was consecutive sampling, satisfy inclusion criteria (< 12 months old, indicate classic symptoms of Hirschsprung’s disease). The total sample of the study was 52 patients. Sensitivity, specificity, positive and negative predictive value were analysed using cross-tabulation test of barium enema and postoperative histopathology. Results: A total of 52 patients were evaluated during the study period, mean of age was 3.31 months old, and boys:girls (75%:25%). Based on symptoms, 98.08% of patients were delayed release of meconium more than 24-48 hours and abdominal distention. Among all the patients reviewed, sensitivity, specificity, positive and negative predictive value of barium enema for diagnostic of Hirschsprung’s disease was 95.5%, 87.5%, 97.7%, and 77.8%. Conclusion: Barium enema can be used as an early diagnostic tool for infants suspected of Hirschsprung’s disease.

Background: Cholelithiasis in children is uncommon and challenging to diagnose because the patient is often asymptomatic and the clinical feature doesn't clearly depict cholelithiasis or cholecystitis. This case study aims to describe a rare case of cholelithiasis with chronic cholecystitis in a ten-year-old boy.Case Presentation: A ten-year-old boy presented with umbilical pain, nausea, and emesis. Physical examination showed there is no tenderness in all abdominal quadrants with a negative Murphy sign. Laboratory results revealed elevated white blood cell count 20.42x103/?L, elevated erythrocyte sedimentation rate 47.2 mm/hour, normal liver function tests, urine, and stool analysis. He underwent transabdominal ultrasound twice. The latest transabdominal ultrasound showed cholelithiasis, free fluid around the pelvic region due to suspected visceral organ perforation. Laparoscopic cholecystectomy was performed without complication. The result of pathology anatomy examination was chronic cholecystitis. The patient was discharged 3 days after surgery in good condition. The long-term prognosis of the patient was good.Conclusion: Even though the patient is male with good nutritional status (not obese), the patient was in the mean age that was identified as a key contributor to this disease. Ultrasonography examination is a screening modality that is still an excellent diagnostic tool with 95% accuracy even though it is highly operator dependent. Laparoscopic cholecystectomy is a gold standard for management even in children with decreased pain and shorter lengths of stay in the hospital.

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Neonatal appendicitis (NA) is an extremely rare acute abdomen condition, moreover, if it is a chronic suppurative one. The definite risk factor of NA is barely unknown. The signs and symptoms are often nonspecific and appear after perforation occurs. Most of the cases were found unexpectedly during surgery suspected as other diagnoses. A 7-day-old male neonate presenting lethargic and hypoglycemia since 1 st day of life. Patient drunk breast milk right after since he was born. Meconium was produced <24 h. On the 3 rd day of hospitalization, he experienced bilious vomiting and abdominal distension, so nasogastric tube was installed. Physical examination revealed decreased bowel sound. Investigation showed leucocytosis, slightly increased procalcitonin and abdominal X-ray showed that gas distribution lasted until third part of duodenum followed by minimal gas distribution in the distal part of duodenum. The patient was suspected as distal duodenum stenosis or proximal jejunum. Intraoperatively, it was found that there was second part duodenum malrotation and open Ladd’s procedure was done. During Ladd’s procedure, a perforated appendix was also found. The histopathology result revealed that it was a chronic suppurative appendicitis. Patient was discharged in good condition 20 days after surgery. NA is a rare condition with nonspecific signs and symptoms which was usually found accidentally during surgery suspected as other diagnoses.

BACKGROUND: Research related to the impact of multidrug resistant organisms (MDRO) infection on clinical outcomes in burns is still limited. AIM: This study evaluated the effect of MDRO infection on morbidity and mortality of burn patients. METHODS: A single-center retrospective cohort study was conducted on burn patients admitted to the burn unit of Sanglah General Hospital, Bali, between 2018 and 2020. MDRO patients were described as those who had at least one positive MDRO culture. All other patients were included in the non-MDRO group. Measurement and analysis included mortality and five indicators of morbidity: length of stay, duration of antibiotic therapy, sepsis, pneumonia, and acute kidney injury (AKI). RESULTS: Significant associations of MDRO infection were found for duration of antibiotic therapy (0 vs. 7 days), sepsis (odds ratio [OR] 13.90 [95% Confidence interval (CI) 95% 2.88–67.10]), pneumonia (OR 12,67 [95% CI 3.26–49.23]), and mortality (OR 9.75 [95% CI 2.00–47.50]). No significant association was found for the length of stay and the incidence of AKI. Multivariate analysis found that MDRO infection increased risk of sepsis (OR 36.53 [95% CI 2.05–652.45], pneumonia (OR 10.75 [95% CI 1.87–61.86]) and mortality (OR 57.09 [95% CI 1.41–2318.87]). Multivariate analysis of MDRO infection with duration of antibiotic therapy found no independent variables that were significantly related. CONCLUSION: These research findings suggest that MDRO infections are associated with increasing length of antibiotic treatment, sepsis, pneumonia, and mortality in burn patients.

Background: Hernia is a protrusion or protrusion of the contents of a cavity through a defect or weak part of the abdominal cavity wall. The standard procedure in the form of herniotomy for indirect inguinal hernias in children can be performed open surgically or laparoscopically. Because there is still a lot of debate about the inflammatory response and outcomes that arise in patients undergoing laparoscopy and open herniotomy, this study was conducted with the aim of evaluating differences in CRP levels in pediatric patients after open herniotomy and laparoscopic herniotomy and their impact on surgical outcomes in the form of wound healing time, length of hospitalization and postoperative pain. Methods: This study is a prospective cohort study using primary data carried out at Sanglah Central General Hospital (RSUP) Sanglah from January to December 2020. Data in the form of gender, the side of the hernia, age, CRP levels, duration of hospitalization, duration of wound healing , postoperative pain scale, duration of surgery, hemoglobin, and BMI were taken from the patient's medical record. After the data was collected, univariate and bivariate analysis was carried out using SPSS 20. Result: A total of 38 patients who were the subjects of this study in the open surgical and laparoscopic groups were 19 subjects each. The mean CRP level in the open surgical group was higher (4.58 ± 1.82 mg/L) than the laparoscopic group (3.53 ± 1.53 mg/L). The duration of hospitalization and wound healing in the open surgical group was found to be longer (1.11 ± 0.32 days; 6.58 ± 0.51 days) when compared to the laparoscopic group (1.05 ± 0.23 days; 4.42 ± 0.51 days). The mean postoperative pain scale measurement results were higher in the open surgical group (2.84 ± 0.77) compared to the laparoscopic group (1.53 ± 0.51). The results showed that there was a statistically significant correlation (p<0.05; p<0.05) with a weak correlation coefficient (r = 0.468; r = 0.457). Conclusion: The laparoscopic technique was found to be superior in terms of the resulting inflammatory response, duration of wound healing, postoperative pain scale, and duration of hospitalization when compared to the open surgery technique. While the duration of hospitalization between the two groups was the same.   Latar belakang: Hernia merupakan protrusi atau penonjolan isi suatu rongga melalui defek atau bagian lemah dari dinding rongga abdomen. Prosedur standar berupa herniotomi pada hernia inguinal indirek anak dapat dilakukan secara open surgical ataupun laparoskopi. Oleh karena masih banyaknya perdebatan mengenai respon inflamasi dan luaran yang timbul pada pasien yang menjalani laparoskopi dan open herniotomy, penilitian ini dilakukan dengan tujuan untuk mengevaluasi perbedaan kadar CRP pada pasien anak pasca open herniotomy dan laparoskopi herniotomi serta dampaknya terhadap luaran operasi berupa lama penyembuhan luka, lama rawat inap serta nyeri paska operasi. Metode: Studi ini merupakan studi kohort prospektif dengan menggunakan data primer yang dilaksanakan di Rumah Sakit Umum Pusat Sanglah (RSUP) Sanglah sejak Januari hingga Desember 2020. Data berupa jenis kelamin, sisi yang mengalami hernia, usia, kadar CRP, durasi rawat inap, lama penyembuhan luka, skala nyeri pasca operasi, durasi operasi, hemoglobin, dan IMT diambil dari rekam medis pasien. Setelah data terkumpul, dilakukan analisis univariat dan bivariat dengan menggunakan SPSS 20. Hasil: Sebanyak 38 pasien yang menjadi subjek penelitian ini dengan kelompok open surgical dan laparoskopi terdapat masing-masing 19 subjek. Rerata kadar CRP pada kelompok open surgical lebih tinggi (4.58 ± 1.82 mg/L) dibandingkan dengan kelompok laparoskopi (3.53 ± 1.53 mg/L). Durasi rawat inap dan penyembuhan luka pada kelompok open surgical didapatkan lebih lama (1.11 ± 0.32 hari; 6.58 ± 0.51 hari) jika dibandingkan dengan kelompok laparoskopi (1.05 ± 0.23 hari; 4.42 ± 0.51 hari). Rerata hasil pengukuran skala nyeri pasca operasi didapatkan lebih tinggi pada kelompok open surgical (2.84 ± 0.77) dibandingkan dengan kelompok laparoskopi (1.53 ± 0.51). Hasil menunjukkan antara kadar CRP dengan variabel durasi penyembuhan luka dan dengan durasi operasi didapatkan korelasi yang bermakna secara statistika (p<0.05; p<0.05) dengan koefisien korelasi yang lemah (r = 0.468; r = 0.457). Simpulan: Teknik laparoskopi ditemukan lebih unggul dalam hal respon inflamasi yang dihasilkan, durasi penyembuhan luka, skala nyeri pasca operasi, dan durasi rawat inap jika dibandingkan dengan teknik open surgery. Sedangkan durasi rawat inap diantara kedua kelompok adalah sama. Kata Kunci: C-reactive protein, open herniotomy, herniotomi laparoskopi, hernia inguinalis indirek, luaran operasi

INTRODUCTION: Insulinoma is congenital hyperinsulinism of infancy (CHI). It is a type of functional neuroendocrine tumor (NET) in the pancreas that manifests with persistent hypoglycemia caused by inappropriately high secretion of insulin (hyperinsulinemia). Comprehensive and multidisciplinary management is required for a better outcome. CASE PRESENTATION: A 2-months-old girl came to the Emergency unit Sanglah Hospital, with a chief complaint of seizure. The patient had a low blood glucose level, high fasting insulin, high LDH, computed tomography of the abdomen result showed isodense heterogeneous lesions border in the cauda pancreas with size 1.32 × 1.24 × 1.35 cm. The anatomy-pathological result showed pancreatic neuroendocrine tumor WHO Grade II, functional, consistent, and clinically to insulinoma on the tail of the pancreas. The patient was treated with hydrocortisone, nifedipine, and octreotide. The patient underwent laparotomy partial pancreatectomy. In post-surgery condition, she had good drink tolerance, no episode of recurrent seizure, and blood glucose was controlled. CONCLUSION: Insulinoma is a rare disease. The diagnosis was challenging. This case report presents the diagnostic work-up and management of a patient with a persistent hypoglycemia condition that was diagnosed as insulinoma.

Background: Long-gap Esophageal Atresia (LGEA) remains one of the most challenging congenital conditions. When primary anastomoses attempts had failed, esophageal replacement (ER) is indicated in these patients. Some infants with LGEA are born with other congenital anomalies, such as rectourethral fistula. In this study, we reported our experience in managing newborn with LGEA and rectourethral fistula. Case: A 1-day-old male neonate complained of unable to swallow any breast milk and presence of feces-like discharge from external urethral orifice within 24 hours after birth. Oral gastric tube was unable to pass into the stomach and x-ray examination revealed curled gastric tube in esophagus, and there wasn’t any bubble seen from patient’s stomach. Patient then was diagnosed with long gap esophageal atresia without fistula. Esophageal replacements using left colon interposition technique was performed as closing and final procedure.  Gastrostomy tube insertion, sigmoid colostomy, and cervical esophagostomy were immediately performed. Posterior sagittal anorectoplasty (PSARP) for patient’s recto-urethral fistula were performed six months after sigmoid colostomy. Patient was hospitalized with total of 32 days and gastric feeding tube can be removed three months after surgery. Conclusion: colon interposition can be safely used in long gap esophageal atreasia although patient had undergone previous colostomy repair. Long-term follow up will be needed. Further large-scale studies regarding this matter are necessary and hopefully comprehensive treatment can be established in the future.