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General Approach to Emergency General Surgery

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Textbook of Emergency General Surgery

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Abstract

Many emergency conditions related to abdominal perforation, obstruction, inflammation/infection, ischemia, and hemorrhage can present acute abdomen, leading to urgent attention, fast diagnosis, and treatment. Acute abdominal pain may be caused by many different etiologies, ranging from self-limiting to life-threatening pathologies (Gans SL et al., Dig Surg 32:23–31, 2015; Swanson SM, Strate LL, Ann Intern Med 168:ITC65–ITC80, 2018).

This chapter contains evidence-based recommendations for the management of patients with intra-abdominal emergencies.

The general approach should include a thorough history and physical exam. The location of the pain is crucial as it may sign a localized process. However, in patients with organ rupture and free air inside the peritoneal cavity, it may present diffuse abdominal pain. The initial management should include labs and image exams such as X-Ray, Computed-Tomography Scan, Ultrasonography, and Magnetic Resonance Imaging if available and the patient is stable (Mayumi T et al., Jpn J Radiol 34:80–115, 2016).

The surgeon has a critical role in the patient’s diagnosis, treatment, and routine evaluation of abdominal emergencies. The X-Ray and CT Scan remain the mainstays to confirm the diagnosis and develop a possible surgical approach. Ultrasound (US) has a continued critical role in analyzing the patient’s evaluation, particularly for evaluating fluid collection inside the abdomen. Magnetic resonance imaging (MRI) has a growing part in the initial assessment and follow-up of selected patients with various abdominal emergencies. Although it is challenging to cover every aspect of a general approach to general emergency surgery in a single chapter, an overview is presented, with key concepts and teaching points (Mayumi T et al., Jpn J Radiol 34:80–115, 2016).

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References

  1. Sartelli M, et al. 2013 WSES guidelines for management of intra-abdominal infections. World J Emerg Surg. 2013;8(1):1–29.

    Google Scholar 

  2. Mayumi T, et al. The practice guidelines for primary care of acute abdomen 2015. Jpn J Radiol. 2016;34(1):80–115.

    Article  PubMed  Google Scholar 

  3. Grundmann RT, et al. The acute (surgical) abdomen-epidemiology, diagnosis and general principles of management. Zeitschrift fur Gastroenterologie. 2010;48(6):696–706.

    Article  CAS  PubMed  Google Scholar 

  4. Addiss DG, et al. The epidemiology of appendicitis and appendectomy in the United States. Am J Epidemiol. 1990;132(5):910–25.

    Article  CAS  PubMed  Google Scholar 

  5. Feliciano DV, et al., editor. Trauma, 9th ed. McGraw Hill; 2020.

    Google Scholar 

  6. Sabiston, textbook of surgery. 20th ed. 2016. p. 1121–1137.

    Google Scholar 

  7. Biffl WL, Leppaniemi A. Management guidelines for penetrating abdominal trauma. World J Surg. 2015;39(6):1373–80.

    Article  PubMed  Google Scholar 

  8. Gans SL, Pols MA, Stoker J, Boermeester MA, Expert Steering Group. Guideline for the diagnostic pathway in patients with acute abdominal pain. Dig Surg. 2015;32(1):23–31. https://doi.org/10.1159/000371583. Epub 2015 Jan 28.

    Article  PubMed  Google Scholar 

  9. Vasilescu A, Occhionorelli S, Venara A, Vereczkei A, Vettoretto N, Vlad N, Walędziak M, Yilmaz TU, Yuan KC, Yunfeng C, Zilinskas J, Grelpois G, Catena F. Prospective Observational Study on acute Appendicitis Worldwide (POSAW). World J Emerg Surg. 2018;13:19. https://doi.org/10.1186/s13017-018-0179-0. PMID: 29686725; PMCID: PMC5902943.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Leppäniemi A, Tolonen M, Tarasconi A, Segovia-Lohse H, Gamberini E, Kirkpatrick AW, Ball CG, Parry N, Sartelli M, Wolbrink D, van Goor H, Baiocchi G, Ansaloni L, Biffl W, Coccolini F, Di Saverio S, Kluger Y, Moore E, Catena F. 2019 WSES guidelines for the management of severe acute pancreatitis. World J Emerg Surg. 2019;14:27. https://doi.org/10.1186/s13017-019-0247-0. PMID: 31210778; PMCID: PMC6567462.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Broek T, Richard PG, et al. Bologna guidelines for diagnosis and management of adhesive small bowel obstruction (ASBO): 2017 update of the evidence-based guidelines from the world society of emergency surgery ASBO working group. World J Emerg Surg. 2018;13(1):1–13.

    Google Scholar 

  12. Ripollés T, Sebastián-Tomás JC, Martínez-Pérez MJ, Manrique A, Gómez-Abril SA, Torres-Sanchez T. Ultrasound can differentiate complicated and uncomplicated acute colonic diverticulitis: a prospective comparative study with computed tomography. Abdom Radiol (NY). 2021;46(8):3826–34. https://doi.org/10.1007/s00261-021-03060-5. Epub 2021 Mar 25. PMID: 33765176.

    Article  PubMed  Google Scholar 

  13. Laméris W, van Randen A, Bipat S, Bossuyt PM, Boermeester MA, Stoker J. Graded compression ultrasonography and computed tomography in acute colonic diverticulitis: meta-analysis of test accuracy. Eur Radiol. 2008;18(11):2498–511. https://doi.org/10.1007/s00330-008-1018-6. Epub 2008 Jun 4. PMID: 18523784.

    Article  PubMed  Google Scholar 

  14. Mattson B, Dulaimy K. The 4 quadrants: acute pathology in the abdomen and current imaging guidelines. Semin Ultrasound CT MR. 2017;38(4):414–23. https://doi.org/10.1053/j.sult.2017.02.006. Epub 2017 Feb 20. PMID: 28865530.

    Article  PubMed  Google Scholar 

  15. Vauth C, Englert H, Fischer T, Kulp W, Greiner W, Willich SN, Stroever B, von der Schulenburg JMG. Sonographic diagnosis of “acute abdomen” in children and adults. GMS Health Technol Assess. 2005;1:Doc08. PMID: 21289929; PMCID: PMC3011316.

    PubMed  PubMed Central  Google Scholar 

  16. Heiken JP, Katz DS, Menu Y. Emergency radiology of the abdomen and pelvis: imaging of the non-traumatic and traumatic acute abdomen. Dis Abdom Pelvis. 2018–2021 (2018):123–143.

    Google Scholar 

  17. Koizumi M, Takada T, Kawarada Y, Hirata K, Mayumi T, Yoshida M, Sekimoto M, Hirota M, Kimura Y, Takeda K, Isaji S, Otsuki M, Matsuno S, JPN. JPN guidelines for the management of acute pancreatitis: diagnostic criteria for acute pancreatitis. J Hepatobiliary Pancreat Surg. 2006;13(1):25–32. https://doi.org/10.1007/s00534-005-1048-2. PMID: 16463208; PMCID: PMC2779365.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Patterson JW, Kashyap S, Dominique E. Acute abdomen. 2021.

    Google Scholar 

  19. You H, et al. The management of diverticulitis: a review of the guidelines. Med J Aust. 2019;211(9):421–7.

    Article  PubMed  Google Scholar 

  20. Swanson SM, Strate LL. Acute colonic diverticulitis. Ann Intern Med. 2018;168(9):ITC65–80. https://doi.org/10.7326/AITC201805010. Erratum in: Ann Intern Med. 2020 May 5;172(9):640. PMID: 29710265; PMCID: PMC6430566.

    Article  PubMed  Google Scholar 

  21. Hecker A, Uhle F, Schwandner T, Padberg W, Weigand MA. Diagnostics, therapy and outcome prediction in abdominal sepsis: current standards and future perspectives. Langenbecks Arch Surg. 2014;399(1):11–22. https://doi.org/10.1007/s00423-013-1132-z. Epub 2013 Nov 2. PMID: 24186147.

    Article  CAS  PubMed  Google Scholar 

  22. Luther B, Mamopoulos A, Lehmann C, Klar E. The ongoing challenge of acute mesenteric ischemia. Visc Med. 2018;34(3):217–23. https://doi.org/10.1159/000490318. Epub 2018 Jun 18. PMID: 30140688; PMCID: PMC6103345.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Krishnamoorthi R, Ramarajan N, Wang NE, Newman B, Rubesova E, Mueller CM, Barth RA. Effectiveness of a staged US and CT protocol for the diagnosis of pediatric appendicitis: reducing radiation exposure in the age of ALARA. Radiology. 2011;259(1):231–9. https://doi.org/10.1148/radiol.10100984. Epub 2011 Jan PMID: 21324843.

    Article  PubMed  Google Scholar 

  24. Sartelli M, et al. 2017 WSES guidelines for management of intra-abdominal infections. World J Emerg Surg. 2017;12:29.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Cristaudo AT, Jennings SB, Hitos K, Gunnarsson R, DeCosta A. Treatments and other prognostic factors in the management of the open abdomen: a systematic review. J Trauma Acute Care Surg. 2017;82(2):407–18. https://doi.org/10.1097/TA.0000000000001314. PMID: 27918375.

    Article  PubMed  Google Scholar 

  26. Como JJ, et al. Practice management guidelines for selective nonoperative management of penetrating abdominal trauma. J Trauma Acute Care Surg. 2010;68(3):721–33.

    Article  Google Scholar 

  27. Catena F, et al. Bowel obstruction: a narrative review for all physicians. World J Emerg Surg. 2019;14(1):1–8.

    Article  Google Scholar 

  28. Kobayashi L, Coimbra R, Goes AMO Jr, Reva V, Santorelli J, Moore EE, Galante JM, Abu-Zidan F, Peitzman AB, Ordonez CA, Maier RV, Di Saverio S, Ivatury R, De Angelis N, Scalea T, Catena F, Kirkpatrick A, Khokha V, Parry N, Civil I, Leppaniemi A, Chirica M, Pikoulis E, Fraga GP, Chiarugi M, Damaskos D, Cicuttin E, Ceresoli M, De Simone B, Vega-Rivera F, Sartelli M, Biffl W, Ansaloni L, Weber DG, Coccolini F. American Association for the Surgery of Trauma-World Society of Emergency Surgery guidelines on diagnosis and management of abdominal vascular injuries. J Trauma Acute Care Surg. 2020;89(6):1197–211. https://doi.org/10.1097/TA.0000000000002968. PMID: 33230049.

    Article  PubMed  Google Scholar 

  29. Andersson M, Kolodziej B, Andersson RE. Validation of the appendicitis inflammatory response (AIR) score. World J Surg. 2021;45(7):2081–91. https://doi.org/10.1007/s00268-021-06042-2. Epub 2021 Apr 6. PMID: 33825049; PMCID: PMC8154764.

    Article  PubMed  PubMed Central  Google Scholar 

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Author information

Authors and Affiliations

  1. Miami University Miller School of Medicine, Miami, FL, USA

    Patricia Correia Sousa Perissé

  2. Division of Trauma and Surgical Critical Care, Miami, FL, USA

    Patricia Correia Sousa Perissé

  3. William Lehman Injury Research Center, Miami, FL, USA

    Antonio Marttos

  4. Division of Trauma and Surgical Critical Care, Miami, FL, USA

    Antonio Marttos

  5. Dewitt Daughtry Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA

    Antonio Marttos

Authors
  1. Patricia Correia Sousa Perissé
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Editor information

Editors and Affiliations

  1. General, Emergency and Trauma Surgery Dept., Pisa University Hospital, Pisa, Italy

    Federico Coccolini

  2. General and Emergency Surgery Dept., Bufalini Hospital, Cesena, Italy

    Fausto Catena

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Perissé, P.C.S., Marttos, A. (2023). General Approach to Emergency General Surgery. In: Coccolini, F., Catena, F. (eds) Textbook of Emergency General Surgery. Springer, Cham. https://doi.org/10.1007/978-3-031-22599-4_2

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  • DOI: https://doi.org/10.1007/978-3-031-22599-4_2

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-22598-7

  • Online ISBN: 978-3-031-22599-4

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