The Infona portal uses cookies, i.e. strings of text saved by a browser on the user's device. The portal can access those files and use them to remember the user's data, such as their chosen settings (screen view, interface language, etc.), or their login data. By using the Infona portal the user accepts automatic saving and using this information for portal operation purposes. More information on the subject can be found in the Privacy Policy and Terms of Service. By closing this window the user confirms that they have read the information on cookie usage, and they accept the privacy policy and the way cookies are used by the portal. You can change the cookie settings in your browser.
Everyone knows that a “good landing” is one from which you can walk away. But, very few know the definition of a “great landing.” It is one after which you can use the airplane another time. Yes, we know that you are tired; you may have worked all night, and this may be the last of many long cases. But, any landing must be perfect, and even this last operation has to succeed.
Not uncommonly—especially with the increased use of diagnostic imaging—when opening the abdomen, the surgeon knows what to expect inside; the clinical picture or ancillary tests direct the surgeon to the disease process. In some instances, however, the surgeon explores the unknown, led on only by the signs of peritoneal irritation, assuming that the peritoneal cavity is flooded with blood or pus....
By far, the most common causes of small bowel obstruction (SBO) are postoperative adhesions and hernias. Other less-common mechanical etiologies are bolus obstruction (e.g., bezoar), malignant or inflammatory (e.g., Crohn’s disease) causes, or intussusception. Hernias causing SBO are discussed in• Chap. 22; early postoperative small bowel obstruction (EPSBO) and paralytic ileus are discussed in •...
At this moment—just as you pick up this book and begin to browse through its pages—there are thousands of surgeons around the world facing a patient with an abdominal catastrophe. The platform on which such an encounter occurs differs from place to place—be it a modern emergency department in London, a shabby casualty room in the Bronx, or a doctor’s tent in the African bush—but the scene itself is...
The long operation is finished, leaving you to savor the sweet postoperative “high” and elation. But very soon, when your serum levels of endorphins decline, you start worrying about the outcome. And worry you must, for the cocksure, macho attitude is a recipe for disaster. We do not intend to bring here a detailed discussion of postoperative care or to write a new surgical intensive care manual....
There are two chief clinical patterns of postoperative intestinal leak: The leak is obvious: you see intestinal contents draining from the operative wound or from the drain site (if a drain was used). You suspect a leak but do not see one.
At Thanksgiving, a national holiday here in the United States, many millions of turkeys—also called “Thanksgiving birds”—are tightly stuffed with various sorts of ingredients (mine would include chickpeas, garlic, wine-soaked bread, and thyme) and served to the assembled members of American families. Granted, these large birds are stuffed postmortem, but what would happen if they were tightly stuffed...
The finding of inflammation, bowel contents, or pus localized or dispersed throughout the peritoneal cavity is common at emergency laparotomy. How is this scenario best handled? This chapter discusses semantic distinctions and general aspects of the surgical treatment. For the management of individual causes of peritonitis, refer to the specific chapters.
The only diaphragmatic pathology of interest to the emergency abdominal surgeon is the diaphragmatic hernia through which one or more abdominal structures may migrate into the thorax and become incarcerated or strangulated. This may occur in different settings, each of which however shares many clinical features.
Five days ago, you removed this patient’s perforated appendix (• Chap. 28); you gave him antibiotics for 2-3 days (• Chap. 47), and by today you expected him to eat (• Chap. 46) and go home. Instead, your patient lies in bed with a long face and a distended abdomen, vomiting bile from time to time. And, the family is asking you what you are asking yourself: what is the problem?
The contents of this chapter could have been summarized in a sentence: an abscess is a pus-containing, confined structure that requires drainage by whichever means available. We believe, however, that you want us to elaborate.
Finally, it is time to “get the hell out of here.” You have been working all night, and it is tempting to finish hastily. Impatience, however, is inadvisable since correct abdominal closure protects the patient from abdominal wound dehiscence (and later on from the development of a hernia) and you from great humiliation (“everybody knows”). Yes, you are tired, but before closing, stop and think; ask...
Remember, we discussed the principles of management of intra-abdominal infection (IAI) (• Chap. 12)? We told you that to improve survival in some patients, source control and peritoneal toilet must be pushed a little further; some patients need a relaparotomy, and in many of these the abdomen is left open (laparostomy). These modalities are now discussed in greater detail. At the end of the chapter,...
When treating a patient with acute abdominal pain, it is tempting to make extensive use of ancillary investigations. This leads to the emergence of “routines” in the emergency room (ER), by which every patient with acute abdominal pain undergoes a plain X-ray of the abdomen (AXR) and a series of blood tests, which typically include a complete blood count, routine blood chemistry, and serum amylase...
Acute cholecystitis is initiated by a gallstone, which obstructs the gallbladder’s outlet. Its spontaneous dislodgement results in so-called biliary colic, while persisting impaction of the stone produces gallbladder distension and inflammation, namely, AC. The latter is initially chemical, but gradually, as gut bacteria invade the inflamed organ, infection supervenes. The combination of distension,...
It is common practice to administer broad-spectrum antibiotics before a laparotomy for an acute surgical condition or trauma. In this situation, antibiotics are either therapeutic or prophylactic.
Set the date range to filter the displayed results. You can set a starting date, ending date or both. You can enter the dates manually or choose them from the calendar.