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Geriatrics/Frailty and End of Life Care

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The Acute Management of Surgical Disease

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Abstract

Mr. S was a 78-year-old man who was brought to the emergency room by his son for complaints of abdominal pain and altered mental status over the past 24 h. He lived at home with his son who helped him buy groceries and manage his finances, but he was independent for the rest of his daily activities. He had been hospitalized twice in the past 6 months for exacerbations of chronic medical problems and had lost 15 pounds over that time which his son attributed to the patient’s disinterest in eating and poor appetite. On exam he was tachycardic with focal peritonitis. CT scan was notable for pneumatosis in the right colon and portal venous gas. Labs revealed a leukocytosis and mild lactic acidosis. The Acute Care Surgery team recommended exploration with possible bowel resection and had a lengthy discussion with the patient and his son about the operation. They also discussed what non-operative management would entail and the implications of poor outcomes after either decision to operate or not. After this discussion, the patient was taken to the OR.

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Authors and Affiliations

  1. Section of Palliative Care, Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University, Nashville, TN, USA

    Mohana Karlekar

  2. Surgery and Medicine, Vanderbilt University Medical Center, Nashville, TN, USA

    Myrick C. Shinall Jr

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  1. Mohana Karlekar
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  2. Myrick C. Shinall Jr
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Correspondence to Mohana Karlekar .

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Editors and Affiliations

  1. Trauma and Acute Care Surgery, Department of Surgery, Baylor College of Medicine, Houston, TX, USA

    Martin D. Zielinski

  2. Trauma and Surgical Care Clinic, Vanderbilt University, Nashville, TN, USA

    Oscar Guillamondegui

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Karlekar, M., Shinall, M.C. (2022). Geriatrics/Frailty and End of Life Care. In: Zielinski, M.D., Guillamondegui, O. (eds) The Acute Management of Surgical Disease. Springer, Cham. https://doi.org/10.1007/978-3-031-07881-1_37

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