. The Pattern and Outcome of Surgical Acute Abdomen at (original) (raw)
The role of open abdomen in non-trauma patient: WSES Consensus Paper
World journal of emergency surgery : WJES, 2017
The open abdomen (OA) is defined as intentional decision to leave the fascial edges of the abdomen un-approximated after laparotomy (laparostomy). The abdominal contents are potentially exposed and therefore must be protected with a temporary coverage, which is referred to as temporal abdominal closure (TAC). OA use remains widely debated with many specific details deserving detailed assessment and clarification. To date, in patients with intra-abdominal emergencies, the OA has not been formally endorsed for routine utilization; although, utilization is seemingly increasing. Therefore, the World Society of Emergency Surgery (WSES), Abdominal Compartment Society (WSACS) and the Donegal Research Academy united a worldwide group of experts in an international consensus conference to review and thereafter propose the basis for evidence-directed utilization of OA management in non-trauma emergency surgery and critically ill patients. In addition to utilization recommendations, questions ...
Medical management of the surgical abdomen
Oxford Handbook of Humanitarian Medicine
This chapter provides essential management guidance for medical providers in low-resource environments when surgical services are not readily available. ‘Medical management of the surgical abdomen’ provides practical advice for the non-surgeon on medical management options for an acute abdomen when definitive surgical care is not available.
Predictors of morbidity and mortality post emergency abdominal surgery: A national study
Saudi journal of gastroenterology : official journal of the Saudi Gastroenterology Association, 2018
Emergency surgeries have increased in Saudi Arabia. This study examines these surgeries and associated complications. This was a prospective multicenter cohort study of patients undergoing emergency intraperitoneal surgery from the eight health sectors of Saudi Arabia. Patients' data were collected over 14 days. In total, 283 patients were included (163 men [54.06%]). The majority of cases were open surgery (204 vs. 79). The 24 h and 30-day mortality rates for the cohort were 0.7 and 2.47%, respectively. Twenty-nine patients (10.24%) required re-intervention, while 19 (8.12%) needed critical care admission. The median length of hospital stay was 3 days. Multivariate analysis showed American Society of Anesthesiologist (ASA) classification score (P = 0.0003), diagnosis (P < 0.0001), stoma formation (P = 0.0123), and anastomotic leak (P = 0.0015) to correlate significantly with 30-day mortality. American Society of Anesthesiologist score, diagnosis, stoma formation and anastomo...
A comparative study of pre-operative with operative diagnosis in acute abdomen
Kathmandu University medical journal (KUMJ)
In this observational study (from August 2000 to January 2001) 102 patients of all age group with non-traumatic acute abdomen were studied to see the negative laparotomy rate and the diagnostic accuracy and predictive values of different investigations in acute abdomen. The disease was most common in the age group 20-29 years with male predominance. More than half of the acute abdomen was due to the acute appendicitis. Neutrophil leucocyte count had the highest sensitivity (91.5%) while Plain X-ray abdomen showed the highest specificity (88.8%) and positive predictive value (88.6%) in diagnosing acute abdomen. Urinalysis showed the highest negative predictive value (93.3%). Overall diagnostic accuracy was 78.4%, which was statistically significant (p<0.05). Diagnostic accuracy was highest in bowel obstruction (82.4%) and lowest in peritonitis due to viscus perforation (69.0%). Negative laparotomy rate was 17.6% in the study, which was statistically significant (p<0.05). It was...
Open Abdomen: The Surgeons’ Challenge
Wound Healing - Current Perspectives, 2019
An open abdomen is defined as purposely foregoing fascial closure of the abdomen after the cavity is opened. Management of complex abdominal problems with the open abdomen and temporary abdominal closure techniques has become a common and valuable tool in surgery. Several challenging clinical situations can necessitate leaving the abdominal cavity open after surgery, resulting in an open abdomen. The indications for open abdomen are as follows: Damage control for life-threatening intraabdominal bleeding, severe acute pancreatitis, severe abdominal sepsis, and prevention and treatment of the abdominal compartment syndrome. Damage control surgery is based on a rapid control of bleeding and focuses on reversing physiologic exhaustion in a critically ill or injured patient. In severe abdominal sepsis, the intervention should be abbreviated due to suboptimal local conditions for healing and global susceptibility to spiraling organ failure. Abdominal compartment syndrome (ACS) is commonly encountered and the only solution is decreasing the pressure by decompressive laparotomy. Open abdomen is associated with significant complications, including wound infection, fluid and protein loss, a catabolic state, loss of abdominal wall domain, and development of enteroatmospheric fistula; however, if the indications are clear, it can become a most valuable resource in treating these conditions.
Comparative Analysis of Clinical, Radiological and Operative Findings in Acute Abdomen
2015
A prospective observational study was conducted on 125 patients with acute abdomen to compare clinical, radiological and operative finding. The most common age group was 21-30 years with male preponderance. Nausea or Vomiting were most predominant symptoms in these patients. Anorexia followed by fever was the next important symptom. Guarding was the single statistically significant sign (p=.02), other common signs were tenderness, rigidity, distention, tachycardia and silent abdomen. A total of 59(47.2%) patients had raised total leucocyte count with sensitivity of 47.54%, and specificity of 66.67% respectively (p = .58); differential leukocyte count was raised in 86(68.8%) patients with sensitivity of 70.49% and positive predictive value of 97.73% the test was statistically significant (p = .0092). Appendicitis was the most common cause of laparotomy followed by perforation peritonitis, obstruction and mesenteric ischemia. Diagnostic accuracy of X-ray was 72.86% while that of US wa...
A new era in the management of open abdomen
2017
pen abdomen (OA) is an important step of damage control surgery (DCS) in trauma surgery due the improvement of patient outcomes. The purpose of DCS is to limit the operative time, permitting the patient to return to the intensive care unit for resuscitation. In general surgery, acute compartment syndrome (ACS) is a result of intra-abdominal injury (primary) or splanchnic reperfusion after massive resuscitation. This may include sepsis or pancreatitis. It causes patients to have a low urine output, as well as hypotension and an increase in ventilator pressure. Open abdomen for decompression, , is also an essential treatment for in this category of patient.
Physiotherapy Canada, 2010
Purpose: Immobility and pain are modifiable risk factors for development of venous thromboembolism and pulmonary morbidity after major abdominal surgery (MAS). The purpose of this study was to investigate the effect of abdominal incision support with an elasticized abdominal binder on postoperative walk performance (mobility), perceived distress, pain, and pulmonary function in patients following MAS. Methods: Seventy-five patients scheduled to undergo MAS via laparotomy were randomized to experimental (binder) or control (no binder) groups. Sixty (33 male, 27 female; mean age 58 e 14.9 years) completed the study. Preoperative measurements of 6-minute walk test (6MWT) distance, perceived distress, pain, and pulmonary function were repeated 1, 3, and 5 days after surgery. Results: Surgery was associated with marked postoperative reductions (p < 0.001) in walk distance (P75-78%, day 3) and forced vital capacity (35%, all days) for both groups. Improved 6MWT distance by day 5 was greater (p < 0.05) for patients wearing a binder (80%) than for the control group (48%). Pain and symptom-associated distress remained unchanged following surgery with binder usage, increasing significantly (p < 0.05) only in the no binder group. Conclusion: Elasticized abdominal binders provide a non-invasive intervention for enhancing recovery of walk performance, controlling pain and distress, and improving patients' experience following MAS.
Co-relation between pre-operative imaging findings and per-operative findings in acute abdomen
International Surgery Journal, 2019
Background: The term acute abdomen refers to a sudden, severe abdominal pain that is less than 24 hours in duration. It is in many cases an emergent condition requiring urgent and specific diagnosis and/or surgical interventions. Abdominal pain can be just one of the symptoms. Most frequently its cause is benign and/or self-limited, but more serious causes may require urgent intervention. Many new diagnostic and management aids have been introduced into the surgical decision-making process over the past decade or so to improve clinical performance. Correct pre-operative diagnosis of acute abdomen remains challenging despite good history taking and clinical examination, and improvement in new imaging techniques including computer-aided diagnosis, ultrasound imaging, computed tomography and laparoscopy. These imaging techniques need sophisticated equipment and specialist expertise round the clock which is not feasible always. Hence, we have tried studying the accuracy of clinical corr...