Atlas of Complicated Abdominal Emergencies

The following sections are included:

• Dedication
• Acknowledgements
• Foreword
• Preface
• Contents

Abdominal pain makes up 5% of all emergency department (ED) presentations. Despite our best efforts, a quarter of our patients are discharged and a third admitted with a label of undifferentiated abdominal pain. The challenges of evaluating an abdominal pain patient in the ED are multiple and include a heterogeneous population, benign conditions and life-threatening ones, intra-abdominal and even extra-abdominal ailments. This is compounded by the fact that most associated symptoms lack specificity and atypical presentations are not uncommon…

Patients with complicated abdominal emergencies invariably present with sepsis and/or shock due to the perforated bowel contents and haemorrhage, respectively. Resuscitation and perioperative management aim to restore the physiology of the patient in preparation for surgery and hence to optimise the outcomes of intervention…

The following sections are included:

• Introduction
• Management of Non-Variceal Upper Gastrointestinal Bleeding
• References

The following sections are included:

• Introduction
• Grading and Nomenclature of Varices
• Management of Variceal Bleeding
• References

The following sections are included:

• Introduction
• Management Options
• Outcomes
• References

The following sections are included:

• Indications
• Preoperative Preparation
• Operative Procedures for Bleeding Peptic Ulcer
• Surgical Techniques for Bleeding Gastric Ulcer
• References

The following sections are included:

• Indications
• Preoperative Preparation
• Operative Treatment
• References

The following sections are included:

• Introduction
• General Complications
• Acute Abdominal Complications

The following sections are included:

• Indications
• Preoperative Preparation
• Surgery
• Postoperative care

The following sections are included:

• Introduction
• Management of Acute Sigmoid Colonic Diverticulitis
• Intra-Operative Surgical Techniques
• References

The following sections are included:

• Introduction
• Preoperative Management
• Management Options
• Endoscopic Colonic Stenting
• Defunctioning Stoma
• Resectional Surgery With or Without Primary Anastomosis
• Clinical Consideration after Surgery
• References

• Acute cholecystitis accounts for 3–9% of hospital admissions for acute abdominal pain.^1,2
• The majority of patients with upper abdominal complaints are subsequently found to have a relatively benign cause of pain or non-specific abdominal pains,² but the possibility of acute cholecystitis must be ruled out with a comprehensive diagnostic evaluation.
• Laparoscopic cholecystectomy is now advocated by clinicians based on lower complication rates, reduced costs, and shortened hospital stay.

Biliary obstruction presenting with symptoms of cholangitis can occur as a result of choledocholithiasis, malignancy, or injury to the bile duct. Sepsis from biliary obstruction is life threatening. ERCP plays a central role in the diagnosis of biliary pathology, immediate relief of obstruction and helps healing of bile duct injuries.

Common surgical emergencies of the bile duct and pancreas include:

• Acute cholangitis
• Acute pancreatitis with or without necrosis
• Bile duct injuries during surgery
• Pancreatic trauma
• ERCP perforation

The following sections are included:

• Introduction
• Management Strategy for Liver Abscesses
• Operative Procedure Via Laparoscopic Approach
• Postoperative Management
• Special situations
• Final Note

The following sections are included:

• Introduction
• Advantages of Radiological Drainage
• Disadvantages of Radiological Drainage
• Radiological Evaluation of the Abscess
• Patient Preparation for Radiological Drainage
• Role of Radiological Intervention
• Technique
• Tips on Drain Insertion and Maintenance
• Site Specific Comments on Radiological Drainage of Intra-Abdominal Abscess
• Conclusion
• References

Gynaecological emergencies, associated with haemorrhage, torsion or sepsis, may present as acute abdomen. They include:

• Ectopic pregnancy
• Ruptured tubo-ovarian abscess, and
• Bleeding ovarian cysts and adnexal torsion

The following sections are included:

• Introduction
• Review of Anatomy and Exposure of the Ureter
• Repair of Bladder Injuries
• Basic Direct Anastomotic Repair of the Ureter
• Ureteroneocystostomy (Ureteric Reimplantation) and Psoas Hitch
• Boari Flap
• Other Manoeuvres
• Post-Operative Care
• Conclusion

Ruptured or leaking abdominal aortic aneurysms are associated with a significantly high mortality rate, ranging from 50% to 80% in the preoperative period. The main determinant of survival is prompt diagnosis and emergent surgery. The classical presentation is the triad of a pulsatile abdominal mass, pallor and hypotension. These patients may give a preceding history of severe central abdominal pain with radiation to the back. In addition they have a significant history of smoking, hypertension and hyperlipidaemia. Frequently, there may not be enough time to elucidate such history from the patients.

The following sections are included:

• Introduction and Indications
• Preoperative Management
• OT Preparation
• Operative Procedure
• Wound Closure
• Postoperative Care

The following sections are included:

• Introduction
• Preoperative Planning
• Choice of Surgical Technique
• Operative Procedure
• Postoperative Management
• References

There are distinct anatomic and physiologic characteristics that impact the management of a child with a surgical abdomen…

The following sections are included:

• Introduction
• Benefits of Laparoscopy in Emergency
• Indications of Emergency Laparoscopy
• Instrumentation
• Patient Position and O.T. Setup
• Dissection, Retraction and Haemostasis
• Suggested Reading

The following section is included:

• Index