Ileus Obstruction Research Articles

039. Obstructive Ileus Caused by Colitis Tuberculosa: A Case Report

Background: Gastrointestinal TB (GTB) constituting approximately 1% to 3% of all TB globally and characterized including of any part of digestive system and its related organs. Results: A 61 years old man was admitted to emergency departement with abdominal pain and abdominal distention since 6 months and getting worse in 1 day. He also complained dispneu. On examination, the abdomen was rigid, distended, and tender and the lung has wheezing. The radiographs of abdomen revelved dilated loops of the small intestine with multiple air-fluid levels suggestive of small intestine obstruction. A chest radiograph showed active TB with opacity of the right lung. The patient was planned for exploratory laparotomy and founded anastomosis, peritoneal deposits, matted bowel, and a perforation of ileus. Intraoperative biopsy was taken from the ileus perforation and revelved tuberkulosa infected. Postoperatively, he was started antituberculous theraphy (ATT) of Rifampicin, isoniazid, and ethambutol (RHE). Conclusion: Obstructive Ileus is a complication of gastrointestinal tuberculosis in patients with a history of untreated latent tuberculosis.

015. A Gastrointestinal Infantile Hemangioma: A Rare Case Report and Literature Review

Background: Small intestinal hemangioma in children is a rare case. The most common predilection is jejunum area. History taking, physical examination, and supporting examinations are needed to help establish the diagnosis. Case: 1 year old girl came with complaints of vomiting with blood since the age of 6 months with frequency 10x/day everytime she eats and drinks. The patient has been given treatment according to the diagnosis of pulmonary tuberculosis and digestive problem, then referred to dr. Kariadi hospital because there was no improvement. Based on examinations, the patient was diagnosed with obstructive ileus at the level of jejunum and exploratory laparotomy was performed. Multiple hemangiomas of 14 x 5 cm were found in the jejunum and confirmed by anatomic pathological examination. Six days after the operation, the child was allowed to go home. Conclusion: Although this case is a rare case in children and include benign tumors, it is necessary to perform a quick diagnosis and appropriate management to prevent mortality and morbidity in children due to gastrointestinal bleeding.

006. Wilm’s Tumor with Obstructive Ileus in A Newborn

Background: Wilms' tumor is the most common kidney malignancy in the pediatric population. Wilms' tumor can spread to other organs, pressing on surrounding organs, and causing kidney damage and high blood pressure. This case report aims to report on neonatal patients with Wilms' tumor which complicate into obstructive ileus. This study aims to explore the effect of wilm’s tumor on causing obstructive ileus which can be detrimental to a newborn. Methods: A 21-day-old baby boy was brought in with complaints of a lump in the left abdomen that had been felt since birth. The lump was felt to be growing rapidly and feels hard. Physical examination revealed sunken eyes, dry lips, holosystolic murmur on parasternal line intercostal II-IV, and a solid mass sized 5x4 cm in the left hypochondrium up to left iliac region. Abdominal ultrasound and CT scan confirmed a renal mass. Results: The patient was diagnosed with partial obstructive ileus due to left kidney tumor suppression, suspected Wilms tumor and low intake malnutrition with moderate to severe dehydration. The patient was managed with laparotomy and left nephrectomy. The procedure alleviated all symptoms and upon 1 month follow up, the patient was healthy with good nutrition status. Conclusion: The presence of large abdominal mass in neonates can be a sign of Wilms tumor. This disease can lead to obstructive ileus and can be treated with laparotomy and nephrectomy.

Delayed Diagnosis of Volvulus without Complications in Pediatric Patient : A Case Report

Introduction: Volvulus in children is rare occurrence, it’s only about 3-5% cases in worldwide. Without abdominal radiological examination, it is difficult to make diagnosis of volvulus based on history and physical examination alone. The management procedures are also controversial, as some recommend a non-operative approach, while others recommend an operative approach in the form of Ladd's Procedure or laparoscopy. Sigmoidoscopy or a barium enema can be attempted as an initial treatment for sigmoid volvulus. Objective: The purpose of this case report is to discuss why there was a delay in diagnosis of volvulus in this case and how to deal it. It also discusses the approach to diagnosis and management of volvulus in pediatric patients, both at the primary health center and the hospital, and why in this case. Case presentation: In this case, volvulus occurred in a pediatric patient who had sought treatment at a primary health center with a complaint of abdominal pain for nine days without improvement. The complaint was accompanied with constipation and fever. Due to limited facilities in primary health center, the patient was referred to the hospital. Result: At the hospital, after taking the history, performing physical examination, and conducting radiological examination and laboratory tests, the patient was diagnosed with ileus obstruction due to volvulus. Conclusion: Although volvulus is a rare case, volvulus should still be included as a differential diagnosis of abdominal pain in pediatric patients to avoid delayed diagnosis. Delay in diagnosis and management of volvulus can lead to serious complications and even life-threatening conditions

Successful Management of Complex Intestinal Tuberculosis with Ileal Perforation: A Case Report

Background: Intestinal tuberculosis (ITB) with ileal perforation represents a formidable challenge in the realm of extrapulmonary tuberculosis. This case report underscores the complexities inherent in managing such cases, highlighting the critical need for a multidisciplinary approach that integrates pharmacological and surgical interventions. Case presentation: A 57-year-old male presented with a history of both pulmonary and intestinal tuberculosis, complicated by ileal perforation. He had previously undergone a six-month course of anti-tuberculosis treatment and a laparotomy for ileal perforation repair. The patient's current presentation included abdominal pain, nausea, and vomiting, indicative of obstructive ileus. Diagnostic assessments revealed elevated inflammatory markers and imaging confirmed partial obstructive ileus and active pulmonary tuberculosis. The patient was managed with extended anti-tuberculosis therapy and intravenous antibiotics, resulting in significant clinical improvement and enhanced quality of life. Conclusion: This case report emphasizes the importance of early detection, comprehensive assessment, and individualized treatment plans in managing complex ITB cases. The successful outcome achieved in this case underscores the efficacy of a multidisciplinary approach that combines pharmacological and surgical interventions.

Characteristics of Obstructive Ileus: Literature Review

Obstructive ileus or often called bowel obstruction is one of the pathological processes that cause abdominal distress. Abdominal distress is an emergency condition in the abdominal cavity. This condition usually arises suddenly with the main complaint of pain. This study aims to see the characteristics of obstructive ileus. The research design used in this study is a literature review using Google scholar in finding previous related articles. The criteria for related articles used were those published from 2021-2024 and 20 journals were collected. Based on these 20 journals, it was found that the characteristics of obstructive ileus were mostly in adulthood and the elderly, based on gender, many were found in men due to lifestyle, while based on the cause of postoperative adhesions and based on symptoms that abdominal pain, nausea, vomiting, and abdominal distension were clinical features of obstructive ileus sufferers.

Unexpected Rupture of Ectopic Pregnancy with Shock: A Warning to Always Enhance Alertness

Introduction: Ectopic pregnancy (EP) describes a pregnancy that develops outside the uterine cavity. The fallopian tube, specifically the ampulla is the most common site. Positive blood β-hCG levels can identify EP with no ultrasound confirmation of intrauterine or extrauterine pregnancy. Case Presentation: We report a 37-year-old woman was referred from primary health care with a diagnosis of ileus. The patient complained of abdominal pain, spotting, vomiting, and no defecating since the day before; gestational age was estimated at around seven weeks. Vital signs indicated shock; the physical examination revealed slight abdominal distention, decreased bowel sounds, tenderness throughout the abdominal area, slightly defans muscular, and hyper tympanic. Vaginal touch didn't reveal cervical dilation, absent portio swaying pain. The laboratory found anemia and leukocytosis with a predominance of neutrophils. The pregnancy test was positive in the emergency department. Previously, the primary health care facility did not undergo a pregnancy test. Abdominal x-ray showed low-lying obstructive ileus and ascites in the pelvic cavity. Transabdominal ultrasound revealed free fluid in the rectouterine cavity. The patient underwent an emergency laparotomy, and a rupture in the ampulla segment was found, then a salpingectomy was performed. Conclusion: Clinicians must be able to diagnose EP correctly and as quickly as possible. In women of childbearing age presenting with acute abdominal complaints and a known or unknown history of menstruation, we strongly recommend a qualitative β-hCG examination, which can be carried out in health facilities with limited resources and at affordable costs, will be very useful for diagnosing and screening ectopic pregnancy.

From Headaches to Obstructive Ileus: Following the Dots

Meningioma and colorectal cancer can co-exist in the same patient and may share mutations in common genetic loci and similar cellcycle regulating proteins in comparable mechanisms of action.

Various Clinical Manifestation of Omphalomesenteric Duct Remnant in a Child: A Case Report

Omphalomesenteric duct (OMD) remnant is a condition in which the omphalomesenteric duct fails to obliterate completely or partially. Failure in this step can produce various patterns, such as a vitelline cyst, umbilical sinus, polyp, Meckel’s diverticulum, and patent OMD. Various clinical manifestations of OMD rarely occur in one patient. We present the case of omphalomesenteric duct remnant, manifested as anterior wall abdominal mass, intraperitoneal hemorrhage, and obstructive ileus. Case report: A four-year-old girl was referred to our hospital with obstructive ileus and abdominal wall mass on the left lower quadrant. Contrast-enhanced abdominal computed tomography (CT) scan found an irregular cystic mass in the abdominal cavity that adheres to the anterior wall of the abdomen and bowel structure with a fluid-solid level without enhancement. Further medical history was taken and found a history of intermittent watery umbilical discharge that appears three times in 2 years after birth. Omphalomesenteric duct remnant was suspected, then proceed to exploratory laparotomy. We found intraperitoneal hemorrhage and 5x4 centimeters frail mass adhering to the anterior wall of the abdomen on the left side of the umbilicus. Histopathological examination confirmed intestinal tissue, suggesting remnants of the omphalomesenteric duct and pancreatic tissue with a chronic inflammatory pattern. Diagnosing omphalomesenteric duct remnant could be challenging and should be considered a differential diagnosis of obstructive ileus, particularly if persistent umbilical discharges are also present. On the other hand, early diagnosis and appropriate management of persistent umbilical discharge could prevent a greater outcome.

P955 The effect of appendicectomy on the clinical course of Ulcerative Colitis: Preliminary results

Abstract Background Emerging evidence indicates an immunomodulatory role of the appendix in ulcerative colitis (UC). Previous studies have suggested a beneficial effect of appendicectomy in inducing and maintaining remission. Therefore, appendicectomy may be considered as an alternative or adjunctive treatment in UC. Aim To evaluate the efficacy of appendicectomy in maintaining remission in UC patients. Methods Adult patients with established UC in complete clinical and endoscopic remission (defined as Mayo score <3 with endoscopic subscore of 0 or 1) following medical induction treatment for disease relapse within 12 months prior to randomisation, were enrolled in the Netherlands and United Kingdom. Patients were randomised (1:1) to undergo appendicectomy (intervention group) or continue maintenance medical therapy (control group). The primary outcome was the one-year UC relapse rate (defined as a total Mayo-score score ≥5 with endoscopic subscore of ≥2). To detect a clinically relevant decrease in relapse rate from 40% to 20%, 82 patients per study arm were needed to achieve 80% power. The last patient was included in September 2022, so analysis of the primary outcome parameter is expected to start soon. Trial progress, including the accumulated number of (serious) adverse events (SAE) in both groups, were presented annually to the Data Safety Monitoring Board. Therefore safety data is available. Results In total, 99 patients were included in the intervention group and 99 patients in the control group. There were 86 males and 112 females, with a median age of 41 years (IQR 33-52). Baseline characteristics were comparable in both groups, with the majority of patients having proctitis (38.9%) or left sided colitis (35.9%). Three SAEs were reported in the appendicectomy group, 2 of which were related to the surgical procedure (reintervention for obstructive ileus and postoperative hematoma) and one hospitalisation for clostridium infection. One SAE was reported within the first year in the control group (appendicitis). The one-year reported colitis-associated adverse event rate was significantly lower in the appendicectomy group when compared to the control group (46.4% vs. 63.9%, P=0.02). During follow up there were no colectomies in the appendicectomy group, whereas three patients underwent colectomy for therapy-refractory disease in the control group. Conclusion Appendicectomy in patients with UC has the possibility to decrease the rate of colitis-associated (serious) adverse events. These results suggest that the final analysis of the primary outcome parameter (relapse rate) could demonstrate that appendicectomy is superior to standard medical therapy alone in maintaining remission in these patients.

Strangulated Incisional Hernia Post Appendectomy: A Rare Case Report

Background: Incisional hernia is a condition in which internal organs, such as the intestines, protrude through a previous surgical incision or suture. This occurs due to the failure of the abdominal wall to close properly. The closure of the abdominal wall is influenced by patient-related factors and technical factors during surgery. Incisional hernia following appendectomy is a rare condition, with an incidence rate of less than 0.12%. With this case report, the author aims to contribute to the literature on strangulated incisional hernia post-appendectomy.
 Case presentation: A 42-year-old male presented to the emergency department with complaints of right lower abdominal pain for the past three days. The patient reported a lump that had been intermittently present for the past nine years but became persistent three days ago. The patient had a history of appendectomy nine years ago. Vital signs were relatively stable, and physical examination revealed a bluish mass measuring 10x8x4 cm in the abdomen. Radiological abdominal assessment revealed a high-level obstructive ileus. Subsequently, the patient underwent a laparotomy, and a right hemicolectomy was performed, removing a segment measuring 50 cm from the ileocecal junction to the ascending colon.
 Conclusion: Incisional hernia following appendectomy is a rare complication, but it can occur due to various risk factors, such as surgical site infection, improper choice of suture material, and inappropriate wound closure technique. The management of this condition can involve the use of tension-free synthetic mesh in either laparotomy or laparoscopy.

Perioperative Management on Septic Condition et Causa General Peritonitis: Case Report

Sepsis is a life-threatening systemic pathological condition. Based on WHO, there were 48.9 million cases with 11 million related deaths worldwide in 2017, which is almost 20% of all deaths from disease. Nearly half of all sepsis cases globally occurred in children, with an estimated 20 million cases and 2.9 million deaths. One of the conditions that can cause sepsis is generalized peritonitis. This study is a case report. Primary data was obtained through anamnesis, physical examination, laboratory test and radiology examination. In this case report, a 13-year-old child patient with generalized peritonitis was found due to obstructive ileus causing intestinal perforation, accompanied by sepsis, and underwent laparotomy and colostomy. Appropriate perioperative management is necessary to maintain hemodynamic stability and adequate oxygenation given the presence of sepsis in the patient.

Anesthesia Approach for Nephrectomy in Full-Term Neonate with Suspected Wilms Tumor and Patent Foramen Ovale: A Case Report

Background: Nephrectomy for Wilms tumor presents a considerable challenge in pediatric anesthesia. This study aimed to describe the anesthesia approach for nephrectomy in a full-term neonate with suspected Wilms tumor and patent foramen ovale.
 Case presentation: A 25-day-old male neonate was referred with a longstanding intraabdominal mass present since birth. Echocardiography revealed a patent foramen ovale with a diameter of 2.7 mm and a left-to-right shunt. The patient also had a diagnosis of partial ileus obstruction, likely caused by the tumor's pressure on the left kidney. Preoperative fasting adhered to a "6-4-3-1" regimen. Normoglycemia was maintained throughout the perioperative period. The case was managed under general anesthesia without the use of the rapid sequence induction technique. Caudal analgesia was administered using 1.14 ml of 0.175% bupivacaine. Vigilant monitoring of blood loss, prevention of hypothermia, and effective pain management are vital aspects of the surgical procedure. For postoperative pain management, analgesia and morphine infusion were employed. The patient was then transferred to the neonatal intensive care unit (NICU) for observation for any signs of complications related to anesthesia and surgery.
 Conclusion: Nephrectomy in neonates is one of the challenges of pediatric anesthesia. Pre-anesthesia preparation in relation to hypertension control, analgesia plan and postoperative care site, transfusion strategy, and management of intravascular extension.

Anesthesia Approach for Nephrectomy in Full-Term Neonate with Suspected Wilms Tumor and Patent Foramen Ovale: A Case Report

Introduction: Nephrectomy for Wilms tumor presents a considerable challenge in pediatric anesthesia. This study aimed to describe the anesthesia approach for nephrectomy in a full-term neonate with suspected Wilms tumor and patent foramen ovale.
 Case presentation: A 25-day-old male neonate was referred with a longstanding intraabdominal mass present since birth. Echocardiography revealed a patent foramen ovale with a diameter of 2.7 mm and a left-to-right shunt. The patient also had a diagnosis of partial ileus obstruction, likely caused by the tumor's pressure on the left kidney. Preoperative fasting adhered to a "6-4-3-1" regimen. Normoglycemia was maintained throughout the perioperative period. The case was managed under general anesthesia without the use of the rapid sequence induction technique. Caudal analgesia was administered using 1.14 ml of 0.175% bupivacaine. Vigilant monitoring of blood loss, prevention of hypothermia, and effective pain management are vital aspects of the surgical procedure. For postoperative pain management, analgesia and morphine infusion were employed. The patient was then transferred to the neonatal intensive care unit (NICU) for observation for any signs of complications related to anesthesia and surgery.
 Conclusion: Nephrectomy in neonates is one of the challenges of pediatric anesthesia. Pre-anesthesia preparation in relation to hypertension control, analgesia plan and postoperative care site, transfusion strategy, and management of intravascular extension.

Small bowel volvulus (SBV) due to multiple adhesion in the small intestine: A case report

Introduction: Small bowel volvulus (SBV) is a rare but significant cause of small intestinal obstruction. Ischemia or even infarction is frequently the result. Morbidity and death rates rise when surgical intervention and diagnosis are delayed. Volvulus is a special form of mechanical intestinal obstruction. It happens when a loop of small intestine twists abnormally around the axis of its mesentery. An acute abdomen is a clinical presentation. The bowel itself may become constricted, strangulation of the blood supply, or both may be the source of the symptoms. Case Description: A-49-year old female patient was delivered to the emergency department because of severe pain around her abdomen that lasted for one day with a bloated abdomen. Other symptoms she complained of were nausea, vomiting, fever and constipation since one day before hospitalization. She was transferred to the medical ward and initially diagnosed with abdominal pain due to severe dyspepsia. After four days, her complaints were not improved, and she was diagnosed with intraabdominal obstruction and decided to undergo an emergency laparotomy. During surgery, there was a small bowel volvulus due to multiple adhesion in the small intestine, which caused all of her symptoms. After total 8 days of hospitalization, the patient was finally discharged. Conclusion: Diagnosing SBV can be difficult, especially if the sign of ileus obstruction is not yet fully developed. Early diagnosis and suspicion are pivotal in SBV because a delay in the surgical treatment can be disastrous.

A rare tumor cause of ileus: primary intestinal lymphoma

Primary intestinal lymphomas (PBL) are rare tumors and extranodal lymphomas. They constitute 1% of malignant tumors of the gastrointestinal (GI) system. Colorectal lymphomas constitute 10-20% of all GI lymphomas and are most commonly located in the cecum. For a case to have PBL, in addition to the dominant GI symptoms, the clinical and radiological absence of pathological lymph nodes located outside the intestine, mediastinum, abdomen, or peripheral is required. In addition, there should be no findings in favor of lymphoma in the liver, spleen, and bone marrow. In this report, a 59-year-old female patient who was admitted to the emergency department with a clinical diagnosis of obstructive ileus while being investigated for abdominal pain lasting for 1 month, was operated on because of the development of an acute abdomen and an obstructive mass as a result of imaging, and was reported as having diffuse large cell lymphoma as a result of postoperative pathology, lastly as a result of the examinations performed, primary intestinal lymphoma was detected, and the diagnosis of the disease is presented. Since the first presentation of PBL may be intestinal obstruction and/or perforation due to delayed diagnosis, PBL should be kept in mind in patients presenting with obstructive ileus in emergency admissions.

Colorectal Cancer in a 17-Year-Old Boy: A Case Report

Introduction: Colorectal cancer is the fifth most common malignant neoplasm worldwide. Commonly found in adults, the adolescent population is scarce. Colorectal cancer diagnosed and treated late is potentially associated with the worst prognosis.Case: A 17-year-old boy was admitted to the hospital due to a distended abdomen and abdominal pain, nausea, and vomiting that he had been experiencing seven days prior. The patient neither had a bowel movement nor flatus for the day. Abdominal ultrasound showed a regional intraluminal mass on the right upper quadrant with a suspicion of an appendical mass with a differential diagnosis of intussusception, colon tumor, and obstructive ileus. Acute abdominal series showed small bowel obstruction. When the surgery was performed, there was a tumor in the hepatic flexure of the colon. Histopathological examination revealed colon adenocarcinoma.Conclusion: The incidence of colorectal cancer in adolescents has increased. Right extended hemicolectomy was performed in this case, but the patient refused the chemotherapy. The patient was readmitted to the hospital five months later, was only given palliative therapy in the Intensive Care Unit, and died two weeks later. We believe that had the chemotherapy been performed, the patient might have had a better prognosis. This case report will help increase awareness among doctors and surgeons in including colorectal carcinoma as a differential diagnosis in adolescents so that it can shorten the delay in diagnosis, which in turn will endanger the patient's prognosis.Keywords: Colorectal cancer; Adenocarcinoma; Adolescents

Primary small bowel volvulus in adult: an unusual case report

Small bowel volvulus (SBV) is an uncommon case which the small intestine rotates around its own mesenteric axis. SBV generally occurs in newborns. We report the case of a 69-year-old man who has been coming with complaints of pain all over his abdomen, vomiting, no bowel movement, and flatus since 2 days ago. The patient underwent plain abdominal radiography and was found to have a high-lying obstructive ileus. The patient was treated with exploratory laparotomy surgery and found to have necrotic bowel sections. During the 5 days postoperative, the complaints improved.

Additional surgery in patients with bladder augmentation

Bladder augmentation is an option to protect kidneys and treat incontinence in frequent neurogenic and congenital non-neurogenic disorders. However, patients may need also other procedures to treat incontinence or to aid catheterizations. In addition, the patients are prone to complications. To evaluate complications or additional surgeries in augmentation cystoplasty according to the etiology of the bladder dysfunction. Data on additional surgical procedures related to bladder augmentation were collected from 128 patients who had undergone enterocystoplasty between 1990 and 2019, with a median age of 10.1 years (IQR 7.2-12.8) and a follow-up time of 11.8 years (IQR 5.7-18.6) after augmentation. Eighty-three patients had a neurogenic disease, and 45 patients had a non-neurogenic disease. Bladder neck operations were performed either at the time of or after augmentation for 62 patients (48.4%), more commonly in the non-neurogenic than neurogenic group <0.01. In addition, continent stoma operations in 56 (36.8%) patients were more common in the non-neurogenic group (p<0.01). Ten patients received kidney transplantation (four in the neurogenic, six in the non-neurogenic group); seven of these patients originally had dysplastic kidneys, two developed nephrological kidney disease, and one had hydronephrosis and renal insufficiency at the time of diagnosis of neurogenic bladder. Surgical problems resulting from bladder augmentation were treated in 28 patients (21.8%). The risk for surgical treatment because of complications was 4%, 17%, 24%, 27% and 27% at 1, 5, 10, 15 and 20 years follow up respectively. Complications were more common in patients in non-neurogenic than in patients with neurogenic group (p<0.01). However, the greater proportion of continent stomas in non-neurogenic group explained the difference (Fig.). The most frequent complication requiring surgery during follow-up was bladder stones, which occurred in 24 (18.8%) patients. The first stone was treated at a median of 3.3 years (range 0.3-14.2) after augmentation. Stones were more common in patients with a continent stoma than without (p<0.01). Other indications for surgical treatment were as follows: obstructive ileus in five patients, reduced bladder capacity in three patients, bladder perforation in two patients and lobulated bladder with infections in one patient. The risk for surgical treatment was about 27% in 20-year follow-up after bladder augmentation, because of augmentation related complications. The most prevalent complication was bladder stone, that was mainly associated with continent stomas. Continent stomas were most prevalent in patients with non-neurogenic diagnosis.

Management of CVVHDF for Acute Renal Failure Patients with Sepsis After Post Exploratory Laparotomy Colonic Resection in Intensive Care Unit: A Case Report

Acute renal failure (ARF) is a condition that may occurs in susceptible postoperative patients. The incidence of ARF reaches 30−60% and it is more after major surgery (e.g., laparotomy, heart surgery). It is often caused by hypovolemia, hypoperfusion, and systemic inflammation. Laparotomy is a major and complex operation that can lead to complications including ARF, acute pulmonary edema, sepsis, and increased morbidity and mortality.&#x0D; A 76-year-old female patient underwent exploratory laparotomy for acute abdominal indications with suspected obstructive ileus with sepsis. Postoperatively, the patient was treated in the ICU using a ventilator. On the third day the patient's renal function and urine volume decreased. Creatinine level 5.19 mg/dL, urea 217 mg/dL and urine was 0.2 ml/kg/h. The patient was given diuretics but she did not show clinical and laboratory improvement. We decided to perform hemodialysis with continuous veno-venous hemodiafiltration (CVVHDF) mode because the patient was in septic condition and hemodynamic instability. CVVHDF was performed for three days, periodic laboratory examinations were performed to assess the patient's renal function. After three days CVVHDF, the clinical and laboratory indices improved and the patient could be extubated. Hemodialysis with CVVHDF mode has benefits in ARF, especially if the patient has unstable hemodynamics.&#x0D; Key words: Acute Renal Failure; CVVHDF; Hemodialysis, Laparotomy, Sepsis&#x0D; Citation: Bangun YG, Hidayat H. Management of acute renal failure with CVVHDF in a patient with sepsis after post exploratory laparotomy: a case report. Anaesth. pain intensive care 2022;27(1):131−134.&#x0D; DOI: 10.35975/apic.v27i1.2086&#x0D; Received: December 11, 2022; Reviewed: December 22, 2022; Accepted: January 12, 2023