Textbook of Emergency General Surgery: Traumatic and Non-traumatic Surgical Emergencies

Foreword
Foreword
Foreword
Foreword
Foreword
Preface
Contents
Part I: General Consideration
1: History of Emergency General Surgery
1.1 Introduction
1.2 The Great Era of Surgery and the Origins of Emergency Model
1.3 Emergency Management in Modern Times
1.4 Future Perspectives of Acute Care Surgery
1.5 Conclusion
References
2: General Approach to Emergency General Surgery
2.1 Introduction
2.1.1 Epidemiology
2.1.2 Etiology
2.1.3 Classification
2.1.4 Pathophysiology
2.2 Diagnosis
2.2.1 Clinical Presentation
2.2.1.1 History
2.2.2 Physical Examination
2.2.3 Tests
2.2.3.1 Imaging
2.3 Treatment
2.3.1 Medical Treatment
2.3.1.1 Trauma Victims: ABCDE
2.3.2 Surgical Treatment
2.3.3 Prognosis
References
3: Evaluation of Traumatic and Nontraumatic Patients
3.1 Trauma Patient
3.1.1 Introduction
3.1.2 Diagnosis
3.1.3 Treatment
3.2 Nontraumatic Patient
3.2.1 Introduction
3.2.2 Diagnosis
3.2.3 Treatment
References
Further Reading
4: Prioritizing Acute Care Surgery and Trauma Patients
4.1 Introduction
4.2 Trauma
4.3 Emergency General Surgery
References
5: Triage
5.1 Triage Scales
5.2 Triage in the ED
5.3 Pain Assessment at Triage
5.3.1 Triage Trauma Assessment
5.3.2 Triage Decision-Making
5.4 Triage for Imaging Studies
5.5 Triage to the Intensive Care Unit (ICU)
5.6 Triage in Mass Casualty Incidents (MCI)
References
Further Reading
6: Mass Casualties
6.1 Introduction
6.1.1 Terminology and Definitions
6.2 Diagnosis
6.2.1 Classification
6.2.1.1 Classification of Disasters
6.2.1.2 Natural Disasters
6.2.1.3 Technological Disasters
6.2.2 Disaster Cycle
6.3 Treatment
6.3.1 Medical Response to Mass Casualty Incidents
6.3.1.1 All Hazard Approach
6.3.1.2 Initial Actions at Scene
6.3.1.3 Command - Control
6.3.1.4 Safety
6.3.1.5 Communication
6.3.1.6 Assessment
6.3.1.7 Triage
6.3.1.8 Treatment
6.3.1.9 Transport
6.3.2 Medical Training for Mass Casualties
References
Further Reading
7: Point-of-Care Ultrasound for Emergency General Surgeons
7.1 Introduction
7.1.1 Point-of-Care Ultrasound Significance of Use for Emergency General Surgeons
7.1.2 Ultrasound Concepts and Principles
7.1.3 Transducers and Controls
7.2 Diagnosis: Pocus Daily Application for the Emergency General Surgeon
7.2.1 E-Fast and Rush
7.2.1.1 Practical Key Considerations
Penetrating Cardiac Trauma
Blunt Cardiac Trauma
Performing the Pericardic Window
Blunt Abdominal Trauma
Penetrating Abdominal Trauma
Chest Trauma: Hemothorax
Chest Trauma: Pneumothorax
Performing the Abdominal and Thoracic Windows
7.2.2 Heart
7.2.2.1 Performing the Cardiac Pocus
Left Ventricular Longitudinal Parasternal Window (PLVE) or Long Axis
Left Ventricular Transverse Parasternal Window (PTVE) or Short Axis
Apical Window
Subcostal Window
Preload Evaluation
Contractile Function Evaluation
Assessment of the Right Ventricle
Overload of Right Chambers in Pulmonary Embolism
Cardiac Tamponade
7.2.3 Lungs
7.2.3.1 Performing Pulmonary Pocus
7.2.3.2 Normal Lung
Bat Sign
Pleural Slip, A-Lines, and Seashore Sign
Lines B (Comet Tail)
7.2.3.3 Abnormal Findings: Pleural Effusion
Sharp Signal and Sinusoidal Signal
7.2.3.4 Abnormal Findings: Alveolar Syndromes
Flap Sign and Hepatization
7.2.3.5 Abnormal Findings: Interstitial Syndromes
Lung Rocket Sign
7.2.3.6 Abnormal Findings: Pneumothorax
Lung Point and Stratosphere Signal or Bar Code
7.2.4 Adding Point-of-Care Ecography and Lung Pocus in EGS Practice
7.2.4.1 Acute Respiratory Distress Evaluation
The Blue Protocol
7.2.4.2 Shock Evaluation
The Falls Protocol
Obstructive Shock
Cardiogenic Shock
Hypovolemic Shock
Distributive Shock
7.2.5 Vascular
7.2.5.1 Performing Vascular POCUS
Sagittal (Transversal)/Longitudinal Plane
Color Doppler Mode
Assessment of Deep Venous Thrombosis (DVT)
Cervical Zone Examination Technique
Upper Limb Examination Technique
Lower Limb Examination Technique
Superficial Venous Thrombosis or Thrombophlebitis
Abdominal Aortic Aneurysm
7.2.5.2 The IVC
7.2.6 Ocular Nerve Sheath (ONS) POCUS
7.2.6.1 Ocular Ultrasound and Assessment ONS
7.2.7 POCUS for Intra-abdominal Hypertension
7.2.8 Central Venous Access
7.2.8.1 Obtaining a Central Venous Access with POCUS
7.2.8.2 Dynamic Versus Static Technique
7.2.8.3 Internal Jugular Vein POCUS Access
7.2.8.4 Subclavian Vein POCUS Access
7.2.8.5 Femoral Vein POCUS Access
7.2.9 Paracentesis
7.2.9.1 Performing POCUS Paracentesis
7.2.10 Pericardiocentesis
7.2.10.1 Performing POCUS Pericardiocentesis
7.2.11 Thoracocentesis
7.2.11.1 Performing POCUS Thoracocentesis
7.2.12 Decision Making Assistance
7.2.13 Transversus Abdominal Plane (TAP) Block
7.2.14 POCUS-Guided Quadratus Lumborum Block
References
Further Reading
8: Systemic Response to Injury
8.1 Introduction
8.1.1 The Burden of Trauma
8.1.2 Physiological Effects of Trauma
8.2 Modern Concepts on Systemic Response to Trauma
8.2.1 Cellular Damage
8.2.2 Pro-inflammatory and Anti-inflammatory Responses
8.2.3 Mitochondria
8.2.4 Neutrophil Extracellular Traps
8.2.5 DNA
8.3 Patient Factors
8.3.1 Age
8.3.2 Genetic Predisposition
8.3.3 Co-morbidities
8.4 Surgical and Resuscitative Factors
8.4.1 Surgery
8.4.2 Medication
8.4.3 Traumatic Shock Resuscitation
References
Untitled
9: Coagulation and Thrombosis
9.1 Introduction
9.1.1 Epidemiology
9.1.2 Etiology
9.2 Pathophysiology
9.2.1 Early TIC
9.2.2 Late TIC
9.3 Diagnosis
9.3.1 Early TIC
9.3.2 Late TIC
9.4 Treatment
References
Further Reading
10: Septic Shock
10.1 Introduction
10.1.1 Definition of Sepsis and Septic Shock
10.1.2 Pathophysiology
10.1.3 Epidemiology
10.2 Diagnosis
10.2.1 Screening for Sepsis
10.2.2 The Place for Biomarkers
10.3 Management
10.3.1 Early Recognition
10.3.2 Early Management
10.3.2.1 Identification of the Source
10.3.2.2 Resuscitation
SSC Guidelines Regarding Resuscitation Targets
Fluid Resuscitation
Vasoactive Agents
Monitoring
10.3.3 Antimicrobial Therapy and Control of the Source of Infection
10.4 Prognosis
10.4.1 Mortality and Risk Factors
10.4.2 Long-term Outcomes
10.5 Conclusion
References
12: Principles of Perioperative Management in Acute Care Surgery
12.1 Introduction
12.2 Shock Etiology
12.3 Priorities and Endpoints of Resuscitation
12.4 Primary Survey
12.4.1 Pulmonary
12.4.2 Cardiovascular
12.4.3 Renal
12.4.4 Gastrointestinal
12.4.5 Endocrine
12.4.6 Hematologic
12.4.7 Infectious
References
Further Reading
13: Critical Care Medicine
13.1 Introduction
13.2 Who Is the Critical Care Patient?
13.2.1 The Critical Emergency Surgery Patient
13.2.2 The Critical Trauma Patient
13.2.3 Stratification of Patients
13.3 What Is an ICU?
13.3.1 ICUs Models
13.3.2 ICUs Levels
13.3.3 ICU Workforce
13.3.3.1 Physicians
13.3.3.2 Nurses
13.3.3.3 Allied Health Care Professionals
13.3.4 ICU Service: Operational Requirement
13.4 General Principle of Management
13.4.1 Monitoring
13.4.1.1 Hemodynamic Monitoring
13.4.1.2 Respiratory Monitoring
13.4.1.3 Neurologic Monitoring
13.4.2 Organ Function Support
13.4.2.1 Respiratory Support
13.4.2.2 Ventilation
Emergency General Surgery
Intra-abdominal Hypertension
Open Abdomen
Trauma
References
Untitled
14: Fluid and Blood Management in Traumatic and Non-traumatic Surgical Emergencies
14.1 Introduction
14.2 Diagnosis: When to Administer Fluids?
14.3 Treatment: Choosing the Right Type of Fluid
14.3.1 Crystalloids
14.3.2 Colloids
References
15: Compartment Syndrome
15.1 Introduction
15.2 Intracranial Compartment Syndrome
15.3 Orbital Compartment Syndrome
15.4 Thoracic and Mediastinal Compartment Syndrome [11–16]
15.5 Abdominal Compartment Syndrome [ACS]
15.5.1 Historical Background
15.5.2 Pathophysiology of ACS [16, 26–30]
15.5.2.1 Cardiovascular Effects
15.5.2.2 Pulmonary Dysfunction
15.5.2.3 Renal Sequelae
15.5.2.4 Abdominal Visceral Abnormalities
15.5.2.5 Abdominal Wall Abnormalities
15.5.2.6 Intracranial Derangements
15.5.3 Poly-compartment Syndrome [34, 35]
15.5.4 Recommendations in Management [23–25]
15.5.5 Quaternary ACS [46, 47]
15.6 Extremity Compartment Syndrome
15.6.1 Pathophysiology
15.6.1.1 Prevalence
15.6.1.2 Diagnosis
15.6.2 Problems in Treatment
15.6.2.1 Important Technical Aspects of Fasciotomy [90]
15.7 Miscellaneous Considerations [90]
15.7.1 Nonsurgical Treatment of ECS
15.7.2 Pediatric Acute Compartment Syndrome
15.7.3 Upper Extremity Compartment Syndrome [UECS]
15.7.4 Gluteal Compartment Syndrome
15.7.5 Thigh Compartment Syndrome
15.7.6 Foot Compartment Syndrome
15.8 Summary and Conclusions
References
16: Antibiotic and Antimicotic Therapy
16.1 Introduction
16.2 Surgical Site Infection and Antibiotic Prophylaxis
16.2.1 Antibiotic Prophylaxis
16.2.1.1 Antibiotic Treatments
Head and Neck
Thorax
Intra-abdominal Region
Appendix
Pancreas
16.2.1.2 Gallbladder and Bile Ducts
16.2.1.3 Small Intestine and Colon
Stomach
Orthopedics and Soft Tissue Infection
16.3 Antifungal Drugs
16.4 Diagnosis
16.5 Sepsis
16.6 Conclusion
References
17: Pain Management
17.1 Introduction
17.1.1 Introduction
17.1.2 Pathophysiology of Pain
17.1.3 Special Patients Group
17.1.3.1 The Elderly Patient
17.1.3.2 The Pediatric Patient
17.1.3.3 The Obese Patient
17.1.3.4 Chronic Opiod Therapy: An Opiod Disorder
17.1.3.5 End of Life
17.2 Diagnosis: Assessment of Pain
17.3 Special Settings
17.3.1 Pain Management in the Prehospital Setting and in the Emergency Department
17.3.2 Acute Pain Service
17.3.3 Pain Management in Perioperative Care and in the Intensive Care Unit
17.3.4 Pain Management at Hospital Discharge
17.4 Treatment
17.4.1 Multimodal Pain Management
17.4.2 Non-pharmacological Pain Management
17.4.3 Pharmacological Analgesia
17.4.3.1 Paracetamol
17.4.3.2 NSAIDs
17.4.3.3 Ketamine
17.4.3.4 Opiods
Morphine
Fentanyl-Sufentanil-Remifentanil
Oxycodone-Buprenorphine-Tramadol
Local Anesthetics
17.4.4 Regional Analgesia
References
18: Damage Control Surgery
18.1 Introduction
18.2 Diagnosis
18.2.1 Trauma Patients
18.2.2 Peritonitis
18.2.3 Vascular Emergencies
18.2.4 Pancreatitis
18.3 Treatment
18.3.1 Medical Treatment
18.3.2 Surgical Treatment
18.3.3 Prognosis
References
Further Reading
19: Nutritional Support
19.1 Introduction
19.2 Physiology of Nutrition in Trauma
19.3 Assessment of Malnutrition
19.4 Route of Nutrition: Enteral Vs Parenteral Nutrition
19.5 Timing and Site of Enteral Nutrition
19.6 Nutrition in the Open Abdomen
19.7 Nutrition Protocols
19.8 The Role of the Multidisciplinary Team in Nutritional Support
19.9 Areas of Future Work
19.10 Conclusion
References
Further Reading
20: Palliative Care in the ICU
20.1 Introduction
20.2 Establishing Definitions and A Common Language
20.2.1 The Need for Palliative Care
20.2.1.1 Economic Concerns and Impact
20.2.1.2 Barriers and Solutions to the Implementation of Palliative Care
20.2.1.3 REMAP
20.2.1.4 How and When to Implement Palliative Care
20.3 Integrative, Complementary, and Alternative Medicine
20.4 Spiritual Care
20.4.1 Palliative Intervention: Is There a Role?
20.4.2 Looking Forward: Changing Culture, Education and Research
20.5 Future Research Areas
20.6 Summary
References
21: Immunosuppression in Surgical Patients
21.1 Introduction
21.2 Patients on Steroids
21.2.1 Summary
21.2.2 Secondary Adrenal Insufficiency
21.2.3 Surgical Stress
21.2.4 Diagnosis
21.2.5 Treatment
21.3 Transplanted Patients
21.3.1 Summary
21.3.2 Non-transplant Surgery
21.3.3 Diagnosis
21.3.4 Treatment
21.4 Patients with HIV/AIDS
21.4.1 Summary
21.4.2 Immune Function in HIV and AIDS Patients
21.4.3 Outcomes of Surgery
21.4.4 Perioperative Admission of HAART
21.4.5 Diagnosis
21.4.6 Treatment
21.5 Elderly
21.5.1 Summary
21.5.2 Immunosenescence in Elderly
21.5.3 Aging of the Population
21.5.4 Frailty
21.5.5 Most Common Emergency Surgeries
21.5.6 Diagnosis
21.5.7 Treatment
21.6 Malnutrition
21.6.1 Summary
21.6.2 Definition of Malnutrition
21.6.3 Patients at Risk for Malnutrition
21.6.4 Effects of Surgery
21.6.5 Diagnosis
21.6.6 Treatment
21.7 Malignancy
21.7.1 Summary
21.7.2 Immune Status
21.7.3 Abdominal Complications in Malignancy
21.7.4 Effect of Chemotherapy
21.7.5 Diagnosis
21.7.6 Treatment
References
22: Pregnant Women
22.1 Introduction
22.2 Anatomic Changes in Pregnancy
22.3 Physiological Changes in Pregnancy
22.3.1 Body Fluid Homeostasis
22.3.2 Cardiovascular System
22.3.3 Respiratory System
22.3.4 Nutritional, Gastrointestinal, and Hepatobiliary Adaptations
22.3.5 Genitourinary System
22.3.6 Hematology and Coagulation
22.3.7 Adrenal Glands
22.3.8 Pancreas
22.3.9 Pituitary Gland
22.3.10 Thyroid Gland
22.3.11 Immunology
22.4 Surgical Emergency in Pregnant Women
22.5 Acute Abdomen in Pregnancy
22.6 Etiology and Incidence
References
23: Geriatrics: Traumatic and Non-traumatic Surgical Emergencies
23.1 Introduction
23.2 Traumatic Surgical Emergencies
23.2.1 Traumatic Brain Injury
23.2.1.1 Diagnosis
23.2.1.2 Treatment
23.2.2 Thoracic Injuries
23.2.2.1 Diagnosis
23.2.2.2 Treatment
23.2.3 Intra-abdominal Hemorrhage and Solid Organ Injury
23.2.3.1 Diagnosis
23.2.3.2 Treatment
23.3 Non-traumatic Surgical Emergencies
23.3.1 Intra-abdominal Sepsis from Perforated Viscus (Diverticular and Peptic Ulcer Disease)
23.3.1.1 Diagnosis
23.3.1.2 Treatment
23.3.2 Acute Cholecystitis
23.3.2.1 Diagnosis
23.3.2.2 Treatment
23.3.3 Acute Mesenteric Ischemia
23.3.3.1 Diagnosis
23.3.3.2 Treatment
References
Further Reading
24: Pediatrics
24.1 Introduction
24.1.1 Epidemiology
24.1.2 Pediatric Emergency General Surgery
24.1.2.1 Pediatric Trauma
24.1.3 Etiology
24.1.3.1 Pediatric Emergency General Surgery
Appendicitis
Bowel Obstruction
Meckel’s Diverticulum
Inguinal Hernia
24.1.3.2 Pediatric Trauma
24.2 Diagnosis
24.2.1 Clinical Presentation
24.2.1.1 Pediatric Emergency General Surgery
Appendicitis
Bowel Obstruction
Meckel’s Diverticulum
Inguinal Hernia
24.2.1.2 Pediatric Trauma
24.2.2 Tests
24.2.2.1 Pediatric Emergency General Surgery
Appendicitis
Bowel Obstruction
Meckel’s Diverticulum
Inguinal Hernia
24.2.2.2 Pediatric Trauma
24.3 Treatment
24.3.1 Medical Treatment
24.3.1.1 Pediatric Emergency General Surgery
Appendicitis
Bowel Obstruction
Meckel’s Diverticulum
Inguinal Hernia
Pediatric Trauma
24.3.2 Surgical Treatment
24.3.2.1 Pediatric Emergency General Surgery
Appendicitis
Bowel Obstruction
Meckel’s Diverticulum
Inguinal Hernia
Pediatric Trauma
24.3.3 Prognosis
References
25: Cirrhotic Patients
25.1 Introduction
25.1.1 Epidemiology
25.1.2 Etiology
25.1.3 Classification
25.1.4 Pathophysiology
25.1.4.1 Renal System
25.1.4.2 Cardiovascular System
25.1.4.3 Respiratory System
25.1.4.4 Central Nervous System
25.1.4.5 Coagulation System
25.2 Diagnosis
25.2.1 Clinical Presentation
25.2.2 Tests
25.2.3 Differential Diagnosis
25.3 Treatment
25.3.1 Medical Treatment
25.3.2 Surgical Treatment
25.3.3 Prognosis
25.3.3.1 Ascites
25.3.3.2 Hepatic Encephalopathy
25.3.3.3 Hepatorenal Syndrome
25.3.3.4 Variceal Hemorrhage
25.3.3.5 Venous Thromboembolism Prophylaxis
References
Further Reading
26: Management of Animal Bites: A Global Perspective
26.1 Introduction
26.1.1 Epidemiology
26.1.2 Animal Behavior and Biomechanism of Injury
26.1.3 Anatomical Regions of Injury
26.1.4 Infection of Bite Wounds
26.1.5 Bacteriology
26.2 Diagnosis
26.2.1 History and Physical Examination
26.2.2 Radiological Workups
26.2.3 Laboratory Investigations
26.3 Treatment
26.3.1 General Management
26.3.2 Local Wound Management
26.4 Psychological Impact
26.5 Injury Prevention
References
Selected References
27: Burns, Inhalation, and Lightning Injury
27.1 Introduction
27.1.1 Epidemiology
27.1.2 Etiology
27.1.3 Classification
27.1.4 Pathophysiology
27.2 Diagnosis
27.2.1 Clinical Presentation
27.2.1.1 In Hospital at the Emergency Department
Management consist of the cABCDEffp protocol [6–10] starting with the Primary Survey
c: Catastrophic Bleeding
A: Airway and c-spine
B. Breathing
C. Circulation
D. Disability
E. Exposure
27.2.1.2 The Rule of 9
27.2.1.3 The Hand Rule
27.2.1.4 Lund and Browder
27.2.1.5 Depth of the Burn
27.2.1.6 Fluids
Resuscitation
27.2.1.7 Myoglobinurea
27.2.1.8 Fahrenheit
27.2.1.9 Pain
27.2.1.10 First Option Without Intravenous Access
27.2.1.11 First Option with Venous or Intraosseous Access
27.2.1.12 Radiology
27.2.1.13 Secondary Survey
27.2.1.14 Non-accidental Burns
27.2.1.15 Toxic Gases
Carbon Monoxide (CO)
Cyanide
Electrical Injury
Low-Voltage Injury
High-Voltage Injury
Lightning Injury
Management
Note
27.3 “Acute” Surgical Treatment
27.3.1 Escharotomy
27.3.2 Fasciotomy
27.3.3 Surgical Treatment
27.3.3.1 Excision of the Burn Eschar
27.3.3.2 Skin Graft
27.3.3.3 Full-Thickness Grafts
27.3.3.4 Dermal Substitutes
References
28: Blast: Mechanisms of Injury and Implications upon Treatment
28.1 Introduction
28.2 Mechanisms of Injury
28.2.1 Primary Blast Injury
28.2.1.1 Blast Lung Injury
28.2.1.2 Tympanic Membrane Perforation
28.2.1.3 Blast Intestinal Injury
28.2.1.4 Primary Blast Injury of Solid Organs
28.2.2 Secondary Blast Injury
28.2.3 Tertiary Blast Injury
28.2.4 Quarternary Blast Injury
References
29: Major Bleeding Management and REBOA
29.1 Introduction
29.1.1 Epidemiology
29.1.1.1 History of REBOA
29.1.1.2 Trauma Patients
29.1.1.3 Acute Care Surgery
29.1.1.4 Obstetrical and Gynecologic Patients
29.1.2 Etiology
29.1.3 Classification
29.1.3.1 Hemorrhagic Shock
29.1.4 Pathophysiology
29.2 Diagnosis
29.2.1 Clinical Presentation
29.2.2 Tests
29.3 Treatment
29.3.1 Medical Treatment
29.3.2 Surgical Treatment of Hemorrhage
29.3.2.1 Timing
29.3.2.2 Complications
References
Further Reading
30: Robotics
30.1 Introduction
30.1.1 Historical Overview of Robotics in Surgery
30.1.2 Current Trends in Robotic Surgery
30.2 Robotics in Emergency Surgery
30.2.1 Background
30.2.2 Literature Reports
30.2.3 Advantages and Disadvantages of Robotic Emergency Surgery
30.3 Future Applications and Research Perspectives
30.3.1 Fluorescence-Based Surgery
30.3.2 Telemedicine
30.3.3 Artificial Intelligence in Surgery
30.3.4 Coming-Soon Technologies
References
Further Reading
31: Emergency and Trauma Surgery During Epidemia and Pandemia
31.1 Introduction
31.2 Personal Protective Equipment and Healthcare Workers’ Infection
31.3 Diagnosis: Emergency Surgery and Trauma Care During a Pandemic
31.4 Treatment: The Management of an Infected Patient for an Emergency Surgical Procedure after Admission
31.4.1 The Transfer of the Infected Patient to the Operating Room
31.4.2 The Operating Room Set Up
31.4.3 The Timing of Anesthesia
31.4.4 The Surgical Procedure
31.4.5 After the Surgical Procedure
31.4.6 The Postoperative Management and Discharge of the Patient
References
32: Principles of Management of Surgical Complications
32.1 Introduction
32.2 Classification of Complications
32.2.1 Management of the Risk of the Complications
32.2.1.1 Prevention and Risk Assessment
32.2.1.2 Early Recognition
32.2.1.3 Appropriate and Timely Management of Complications
32.2.2 Common Surgical Complications in the Emergency Setting
32.2.2.1 Hemorrhage
32.2.2.2 Prevention
32.2.2.3 Diagnosis
32.2.3 Management
32.2.4 Postoperative Pain
32.2.4.1 Prevention
32.2.4.2 Diagnosis
32.2.4.3 Management
32.2.5 Fever
32.2.6 Respiratory Complications
32.2.6.1 Prevention
32.2.6.2 Diagnosis
32.2.7 Venous Thromboembolism
32.2.7.1 Prevention
32.2.7.2 Diagnosis
32.2.7.3 Management
32.2.8 Surgical Site Infections (SSIs)
32.2.9 Antibiotic Prophylaxis
32.2.9.1 Diagnosis
32.2.9.2 Management
32.3 Conclusion
References
33: Iatrogenic Complications of Digestive Endoscopy
33.1 Introduction
33.1.1 Epidemiology
33.1.2 Pathophysiology
33.1.3 Other Complications of Digestive Endoscopy
33.1.3.1 Bleeding
33.1.3.2 Small Bowel Perforation
33.1.3.3 Endoscopic Stents and Instruments
33.1.3.4 Adverse Events of Percutaneous Endoscopic Enteral Access
33.1.3.5 Cardiopulmonary Adverse Events
33.1.3.6 Infectious Adverse Events
33.1.3.7 Other Adverse Events
33.2 Diagnosis
33.2.1 Clinical Presentation
33.2.1.1 Colonoscopy Perforations
33.2.1.2 Upper Digestive Endoscopy Perforations
33.2.2 Diagnostic Tests
33.2.2.1 Colonoscopy Perforations
33.2.2.2 Upper Digestive Endoscopy Perforations
33.3 Treatment
33.3.1 Medical Treatment
33.3.1.1 Colonoscopy Perforations
33.3.1.2 Upper Digestive Endoscopy Perforations
33.3.2 Surgical Treatment
33.3.2.1 Colonoscopy Perforations
33.3.2.2 Upper Digestive Endoscopy Perforations
33.3.3 Prognosis
33.3.3.1 Colonoscopy Perforations
33.3.3.2 Upper Digestive Endoscopy Perforations
References
Further Reading 
34: End-of-Life Care, Including the Role of Intensive Care in Tissue and Organ Donation
34.1 End-of-Life Care in ICU
34.2 Organ and Tissue Donation
34.2.1 Brain Death and Organ Donation
34.3 Donation After Cardiac Death
34.4 Conclusion
References
35: Futility of Care and Palliative Care
35.1 Introduction
35.2 The Medical Futility
35.3 Futility and Emergency Surgery
35.4 Challenges, Contrasts, and Their Resolution
35.5 Ethical Foundation and Ethical Implication of Futility
35.6 Palliative Care in Emergency Surgery
References
36: Communication in Emergency General Surgery
36.1 Introduction
36.2 Communication as a Key Component of Teamwork in the OR
36.2.1 What Does Communication in the Perioperative Environment Entails?
36.2.2 External and Internal Determinants Causing Gaps in Communication
36.3 Introducing a Comprehensive Communication Model
36.3.1 Ten Proposals for Breaking the Communication Gap
36.3.2 The Role of Digital Technology and Digital Media
36.3.3 The COVID Experience or How Nonverbal Communication Counts Equally
36.4 Conclusion
References
Further Reading
37: Patient Safety and Risk Management
37.1 Introduction
37.1.1 Patient Safety
37.1.2 Patient Safety in Surgery
37.1.3 Patient Safety in Emergency General Surgery
37.1.4 Risk and Patient Safety
37.2 Diagnosis
37.2.1 Risk Assessment
37.3 Treatment
37.3.1 Risk Management and PS
37.3.2 Risk Management in Health Care
37.3.3 Risk Management in Surgery and Emergency General Surgery
37.3.4 COVID 19 and Patient Safety in Emergency General Surgery
37.3.5 Future of Emergency General Surgery and Patient Safety
References
38: Quality Evaluation in Emergency General Surgery
38.1 Introduction
38.2 Context: Defining the Problem
38.3 Towards Quality EGS Care
38.3.1 Leadership
38.3.2 Patient Care
38.3.3 Emergency Surgical Team and Supporting Staff
38.3.4 Training
38.3.5 Patient Follow-Up, Benchmarking and Quality Initiatives
38.3.6 Designation of Emergency Surgical Services
38.4 EGS Registry
38.5 Emergency Surgery Outcomes Advancement Project (eSOAP)
38.6 Conclusion
References
Part II: Head, Face and Neck
39: Head and Brain Trauma
39.1 Introduction
39.2 Epidemiology
39.3 Pathophysiology
39.3.1 Intracranial Pressure and Cerebral Perfusion Pressure
39.4 Diagnosis
39.4.1 Imaging
39.4.1.1 Skull Fractures
39.4.1.2 Traumatic Subarachnoid Hemorrhage
39.4.1.3 Epidural Hematoma
39.4.1.4 Subdural Hematoma
39.4.1.5 Brain Contusions
39.4.1.6 Diffuse Axonal Injury
39.4.2 Neuromonitoring
39.4.2.1 Neurological Examination
39.4.2.2 ICP Monitoring
39.4.2.3 Brain Tissue Oxygenation Monitoring
39.5 Treatment
39.5.1 CSF Drainage with EVD
39.5.2 Osmotherapy
39.5.3 Hyperventilation
39.5.4 Metabolic Suppression (Barbiturate Coma)
39.5.5 Hypothermia
39.5.6 Decompressive Craniectomy
39.6 Traumatic Brain Injury in Polytrauma Patients
References
Suggested References
40: Emergency Surgical Access to the Neck
40.1 Introduction and Learning Goals
40.2 Surgical Anatomy of the Neck
40.2.1 Arteries
40.2.1.1 Carotid Arteries
40.2.1.2 Subclavian Artery
40.2.1.3 Vertebral Artery
40.2.2 Larynx and Trachea
40.2.3 Pharynx and Esophagus
40.3 Indications of Surgical Access to the Neck
40.3.1 Conditions
40.3.2 Diagnosis
40.3.3 When to Operate the Above-Mentioned Conditions
40.3.3.1 Trauma
40.3.3.2 Infection
40.4 Management
40.4.1 General Strategies in Trauma
40.4.2 Anterior Approach to the Sternocleidomastoid Muscle (ASCM)
40.4.2.1 Indication
40.4.2.2 Position
40.4.2.3 Technical Aspects
40.4.3 Supraclavicular Approach
40.4.3.1 Indication
40.4.3.2 Position
40.4.3.3 Technical Aspects
40.4.4 Sternotomy
40.4.4.1 Indication
40.4.4.2 Position
40.4.4.3 Technical Aspects
40.4.5 Anterior Thoracotomy
40.4.5.1 Indications
40.5 Simplified Approach to Particular Neck Injuries
40.5.1 Airway
40.5.1.1 Cricothyroidotomy
Open Cricothyroidotomy
Percutaneous Puncture
Needle Cricothyroidotomy
40.5.1.2 Tracheostomy
40.5.2 Surgical Access to the  Esophagus
40.5.3 Arteries and Veins
40.5.3.1 Surgical Access to Carotid and Jugular Vein Injuries
Carotid Injuries
Vein Injuries
40.5.3.2 Surgical Access to Vertebral Artery Injuries
40.5.4 Infections Surgical Therapy
References
41: Face and Neck Infections
41.1 Introduction
41.1.1 Epidemiology
41.1.2 Etiology
41.1.2.1 Origin of FNI: Primary Focus of Infection
41.1.2.2 Microbiology
Microbiome of the Head and Neck Mucosal Spaces
Microbiology in Face and Neck Infections
41.1.3 Classification
41.1.4 Pathophysiology
41.1.4.1 Odontogenic Infection Source
41.1.4.2 Tonsil Infection Source
41.1.4.3 Cervical Adenitis
41.2 Diagnosis
41.2.1 Clinical Presentation
41.2.2 Tests
41.2.2.1 Laboratory and Microbiological Tests
41.2.2.2 Diagnostic Imaging Tests
Ultrasound
Contrast Enhanced CT-Scan (CECT)
Magnetic Resonance Imaging (MRI)
41.3 Treatment
41.3.1 Medical Treatment
41.3.1.1 Antibiotic Treatment
41.3.1.2 Assessment and Control of Airway
41.3.1.3 Additional Co-adjuvant Medical Treatments
Corticosteroids
Anticoagulation
41.3.2 Focus Control of Infection
41.3.2.1 Abscess of Canine, Buccal, Vestibular and Palatal Spaces
41.3.2.2 Masticator Space Abscess
41.3.2.3 Parotid Space
41.3.2.4 Debridement of the Floor of the Mouth: Ludwig Angina
41.3.2.5 Debridement of Central Compartment of the Neck.
References
Further Reading
42: Trauma to the Face
42.1 Introduction
42.1.1 Epidemiology
42.1.2 Etiology
42.1.3 Classification
42.2 Diagnosis
42.2.1 Clinical Presentation
42.2.2 Tests
42.3 Treatment
42.3.1 Medical Treatment
42.3.2 Treatment
42.3.3 Prognosis
References
Further Reading
43: Traumatic Neck Injuries
43.1 Introduction
43.1.1 Epidemiology
43.1.2 Etiology
43.1.3 Classification
43.1.3.1 Anatomy
43.1.4 Pathophysiology
43.2 Diagnosis
43.2.1 Clinical Presentation (Symptoms + Physical Findings)
43.2.1.1 Laryngotracheal Injuries
43.2.1.2 Esophageal Injuries
43.2.1.3 Vascular Injuries
43.2.1.4 Cervical Spine Injuries
43.2.2 Tests (Labs, Imaging)
43.3 Treatment
43.3.1 Medical Treatment (Interventional Radiology Included)
43.3.2 Surgical Treatment (Open and MIS Techniques)
43.3.2.1 Laryngotracheal Injuries
43.3.2.2 Esophageal Injuries
43.3.2.3 Vascular Injuries
43.3.3 Prognosis
References
Further Reading
44: Management of Neck Surgery Complications
44.1 Introduction
44.1.1 Epidemiology
44.1.2 Classification
44.2 Inferior Laryngeal Nerve Injury
44.2.1 Epidemiology
44.2.2 Etiology
44.2.3 Pathophysiology
44.2.4 Diagnosis
44.2.4.1 Clinical Presentation
44.2.4.2 Tests
44.2.5 Treatment
44.2.5.1 Medical Treatment
44.2.5.2 Surgical Treatment
44.2.6 Prognosis
44.3 Spinal Accessory Nerve Injury
44.3.1 Epidemiology
44.3.2 Etiology
44.3.3 Pathophysiology
44.3.4 Diagnosis
44.3.4.1 Clinical Presentation
44.3.4.2 Tests
44.3.5 Treatment
44.3.5.1 Medical Treatment
44.3.5.2 Surgical Treatment
44.4 Mandibular Branch of the Facial Nerve Injury
44.4.1 Epidemiology
44.4.2 Etiology
44.4.3 Pathophysiology
44.4.4 Diagnosis
44.4.4.1 Clinical Presentation
44.4.4.2 Tests
44.4.5 Treatment
44.4.5.1 Surgical Treatment
44.5 Phrenic and Vagus Nerve Injuries
44.6 Hypoparathyroidism
44.6.1 Epidemiology
44.6.2 Etiology
44.6.3 Pathophysiology
44.6.4 Diagnosis
44.6.4.1 Clinical Presentation
44.6.4.2 Tests
44.6.5 Treatment
44.6.5.1 Medical Treatment
44.7 Chyle Leak
44.7.1 Epidemiology
44.7.2 Etiology
44.7.3 Pathophysiology
44.7.4 Diagnosis
44.7.4.1 Clinical Presentation
44.7.4.2 Tests
44.7.5 Treatment
44.7.5.1 Medical Treatment
44.7.5.2 Surgical Treatment
44.8 Postoperative Haematoma
44.8.1 Epidemiology
44.8.2 Etiology
44.8.3 Pathophysiology
44.8.4 Diagnosis
44.8.4.1 Clinical Presentation
44.8.4.2 Tests
44.8.5 Treatment
44.9 Major Vessels Injury
44.9.1 Epidemiology
44.9.2 Etiology
44.9.3 Pathophysiology
44.9.4 Diagnosis
44.9.4.1 Clinical Presentation
44.9.4.2 Tests
44.9.5 Treatment
44.9.5.1 Medical Treatment
44.9.5.2 Surgical Treatment
44.10 Tracheomalacia
44.10.1 Epidemiology
44.10.2 Etiology
44.10.3 Pathophysiology
44.10.4 Diagnosis
44.10.4.1 Clinical Presentation
44.10.4.2 Tests
44.10.5 Treatment
44.10.5.1 Surgical Treatment
44.11 Laryngotracheal Complex Injuries
44.12 Pneumothorax
44.12.1 Epidemiology
44.12.2 Etiology
44.12.3 Pathophysiology
44.12.4 Diagnosis
44.12.4.1 Clinical Presentation
44.12.4.2 Tests
44.12.5 Treatment
44.12.5.1 Medical Treatment
44.12.5.2 Surgical Treatment
44.13 Injuries to the Cervical Oesophagus
44.14 Seroma and Wound Infection
References
Further Reading
Part III: Thorax and Mediastinum
45: Emergency Surgical Access to the Thorax
45.1 Introduction
45.2 Diagnosis
45.3 Treatment
45.3.1 Anatomy of the Thorax
45.3.1.1 Thoracic Cavity
45.3.1.2 Thoracoabdominal Boundaries
45.3.1.3 Cardiac Box
45.3.1.4 Subclavian Artery Anatomy
45.3.2 Surgical Incisions
45.3.2.1 Best Approach Incision for Anatomic Injury
45.3.2.2 Finger or Tube Thoracostomy
45.3.2.3 Left Anterolateral Thoracotomy (Resuscitative Thoracotomy)
45.3.2.4 Bilateral Anterolateral Thoracotomy (Clam-Shell Thoracotomy)
45.3.2.5 Posterolateral Thoracotomy
45.3.2.6 Pericardial Window
45.3.2.7 Median Sternotomy
45.3.2.8 Left Subclavian Artery Injury
45.3.2.9 Right Subclavian Artery Injury
References
46: Empyema
46.1 Introduction
46.2 Diagnosis
46.3 Treatment
46.3.1 Stage 1 (Exudative)
46.3.2 Stage 2 (Fibrinopurulent)
46.3.3 Stage 3 (Organized)
46.4 Special Considerations
References
Further Reading
47: Hemothorax and Pneumothorax
47.1 Introduction
47.1.1 Epidemiology
47.1.2 Etiology and Classification
47.1.2.1 Non-traumatic
47.1.2.2 Traumatic
47.1.3 Pathophysiology
47.2 Diagnosis
47.2.1 Clinical Presentation
47.2.2 Tests
47.3 Treatment
47.3.1 Medical Treatment
47.3.2 Surgical Treatment
47.3.2.1 Needle Decompression
47.3.2.2 Tube Thoracostomy
47.3.2.3 Chest Tube Size and Pigtail Catheters
47.3.2.4 Setup of the Pleur-evac or Atrium
47.3.2.5 Heimlich Valves
47.3.2.6 Thoracotomy and VATS for Hemothorax Evacuation
47.3.2.7 VATS Pleurodesis
47.3.2.8 Post-surgical Management
47.3.3 Prognosis and Complications
47.3.3.1 Tube Thoracostomy Complications
47.3.3.2 Persistent Air Leak
47.3.3.3 Tracheobronchial Injury
References
48: Chest Trauma
48.1 Introduction
48.1.1 Epidemiology
48.1.2 Etiology
48.1.3 Classification
48.1.4 Pathophysiology
48.2 Diagnosis
48.2.1 Clinical Presentation (Sxs and Phys Exam)
48.2.2 Tests (Labs, Imaging)
48.3 Treatment
48.3.1 Medical Treatment (Including IR)
48.3.1.1 Immediate Treatment
48.3.1.2 Ongoing Medical Treatment Considerations
48.3.2 Surgical Treatment (Incl Open and MIS)
48.3.2.1 Emergency Department
48.3.2.2 Operating Room
Chest Wall Injury
Lung Injury
Tracheobronchial Injury
Diaphragm Injury
48.3.3 Prognosis (Incl Complications and Their Management)
48.3.3.1 Complications
References
Further Reading
49: Thoracic Vascular Trauma
49.1 Introduction
49.1.1 Epidemiology
49.1.2 Etiology
49.1.2.1 Penetrating Trauma
49.1.2.2 Blunt Trauma
49.1.3 Classification
49.1.3.1 Aorta
Penetrating
Blunt
49.1.3.2 Arch Vessels
Penetrating
Blunt
49.1.3.3 Pulmonary Vessels
Penetrating
Blunt
49.1.3.4 Vena Cava
Penetrating
Blunt
49.1.3.5 Chest Wall Vessels
Penetrating
Blunt
49.1.4 Pathophysiology
49.2 Diagnosis
49.2.1 Clinical Presentation
49.2.1.1 Penetrating
49.2.1.2 Blunt Trauma
49.2.2 Tests
49.3 Treatment
49.3.1 Medical Treatment
49.3.2 Surgical Treatment
49.3.2.1 Aorta
Penetrating
Blunt
Endovascular Repair
49.3.2.2 Arch Vessels
Penetrating
Blunt
Endovascular Repair
49.3.2.3 Pulmonary Vessels
Penetrating
Blunt
49.3.2.4 Vena Cava
Penetrating
Blunt
49.3.2.5 Chest Wall Vessels
Penetrating
Blunt
49.3.3 Prognosis
References
Further Reading
50: Resuscitative Thoracotomy
50.1 Introduction
50.1.1 Definitions of Resuscitative Thoracotomy
50.1.2 Historical Perspective
50.1.3 Objectives of Resuscitative Thoracotomy
50.2 Diagnosis
50.2.1 Assessment of the Trauma Patient
50.2.2 Indications for Resuscitative Thoracotomy
50.3 Pathophysiology
50.3.1 Pericardial Tamponade
50.3.2 Intrathoracic Hemorrhage
50.3.3 Bronchovenous Air Embolism
50.3.4 Open Cardiac Massage
50.3.5 Thoracic Aortic Cross-Clamping
50.4 Treatment
50.4.1 Surgical Technique
50.4.1.1 Thoracic Incision
50.4.1.2 Pericardiotomy and Cardiac Hemorrhage Control
50.4.1.3 Thoracic Aortic Occlusion and Pulmonary Hilar Control
50.4.1.4 Cardiac Massage and Advanced Cardiac Life Support (ACLS) Interventions
50.4.1.5 Markers of Futility
50.4.1.6 Definitive Surgery
50.4.2 Technical Complications
50.4.3 Medical Optimization Following RT
50.4.4 Prognosis
50.4.5 Risks to the Trauma Team
50.4.6 Selective Application of Resuscitative Thoracotomy
References
Further Reading
51: Cardiac Trauma and Tamponade
51.1 Introduction
51.1.1 Epidemiology
51.1.1.1 Blunt Cardiac Injury
51.1.1.2 Penetrating Cardiac Injury
51.1.2 Etiology
51.1.3 Classification
51.1.4 Pathophysiology
51.2 Diagnosis
51.2.1 Clinical Presentation
51.2.1.1 PCI and the “Cardiac Box”
51.2.2 Tests
51.2.2.1 Electrocardiogram (ECG)
51.2.2.2 Laboratory Tests—Cardiac Biomarkers
51.2.2.3 Radiologic Tests
51.2.2.4 Ultrasound and eFAST Exam
51.2.2.5 Echocardiography
51.2.2.6 Computed Tomography Scan
51.2.2.7 Magnetic Resonance Imaging
51.3 Treatment
51.3.1 Medical Treatment
51.3.2 Surgical Treatment
51.3.3 Prognosis
References
Further Reading
52: Management of Cardiothoracic Surgery Complications
52.1 Perioperative Complications in Thoracic Surgery
52.1.1 Introduction
52.1.2 Diagnosis and Treatment
52.2 Perioperative Complications in Cardiac Surgery
52.2.1 Introduction
52.2.2 Diagnosis and Treatment
52.2.2.1 The Main Cardiovascular Complications during the Intensive Treatment Phase
Myocardial Stunning
Low Cardiac Output Syndrome
Postoperative Bleeding
Cardiac Tamponade
Myocardial Infarction
Cardiac Rhythm Disorders
PostPerfusion Syndrome
52.2.2.2 The Main Noncardiovascular Complications During the Intensive Treatment Phase
Anemia and Blood Products
52.2.2.3 Heparin-Induced Thrombocytopenia
Fever
Sternal Instability and Mediastinitis
Acute Kidney Failure
Gastrointestinal Complications
Nonocclusive Mesenteric Ischemia and Ischemic Cholecystitis (NOMI)
Abdominal Bleeding
Hyperbilirubinemia and Hepatic Injury
Neurological Disorders
Postoperative Delirium (POD)
References
53: Acute Congenital and Acquired Heart Disease
53.1 Introduction
53.2 Acute Aortic Syndromes
53.3 Clinical Symptoms and Signs
53.4 Classification
53.5 Technique of Ascending Aorta and Arch Replacement
53.6 Mechanical Complications of Acute Myocardial Infarction
53.6.1 Ventricular Septal Rupture
53.6.2 Rupture of Left Ventricle Free Wall
53.6.3 Papillary Muscle Rupture and Acute Mitral Regurgitation
53.7 Critical Congenital Heart Disease
53.7.1 Hypoplastic Left Heart Syndrome (HLHS)
53.7.2 Transposition of Great Arteries (TGA)
53.7.3 Obstructed Total Pulmonary Vein Connection (oTPVC)
53.7.4 Aortic Coarctation (CoAo)
References
Further Reading
Part IV: Abdomen
54: Principles of Emergency and Trauma Laparotomy
54.1 Introduction
54.1.1 Epidemiology
54.1.2 Etiology
54.1.2.1 Medical or Non-traumatic Situations [9–11]
54.1.2.2 Traumatic Situations
54.2 Classifications
54.2.1 Physiopathology
54.2.1.1 Hemorrhagic Shock: Stop the Bleeding et Limit the Contamination
54.2.1.2 Acute Peritonitis: Control the Sepsis and Prevent Abdominal Hyper Pressure
54.3 Diagnosis
54.3.1 Clinical Presentation
54.3.2 Tests
54.3.2.1 Imaging
54.3.2.2 Lab Tests
54.4 Treatment
54.4.1 Medical Treatment
54.4.1.1 Preoperative Management
54.4.1.2 Postoperative Management
54.4.1.3 Arterial Embolization
54.4.2 Surgical Treatment
54.5 Prognosis
54.1.1 References
55: Principles of Emergency and Trauma Laparoscopy
55.1 Introduction
55.2 Diagnosis
55.3 Indications and Contraindications of Laparoscopy in Surgical Emergencies
55.3.1 Acute Appendicitis
55.3.2 Acute Cholecystitis
55.3.3 Acute Pancreatitis
55.3.4 Perforated Peptic Ulcer
55.3.5 Acute Mesenteric Ischemia
55.3.6 Acute Diverticulitis
55.3.7 Small Bowel Obstruction Due to Adhesions
55.3.8 Incarcerated/Strangulated Hernias
55.3.9 Gynecological Disorders
55.4 Surgical Imaging and Assistance in Emergency Laparoscopy Setting
55.4.1 Indocyanine Green Fluorescence
55.4.2 X-Ray and Fluoroscopy Guidance
55.4.3 Endoscopy and Surgery
55.5 Indications and Contraindications of Laparoscopy in Traumatic Emergencies
55.5.1 Indications for Exploratory Laparoscopy in Abdominal Trauma
55.5.2 Contraindications for the Use of Laparoscopy in Trauma
55.6 Treatment
55.7 Basics in Laparoscopic Surgery for Trauma
55.7.1 Basic Equipment
55.7.2 The Operating Room
55.7.3 Laparoscopic Instruments
55.7.4 Basic Technique
55.7.5 Entry Techniques
55.7.6 Trocar Placement
55.8 Important Issues About Laparoscopy in Trauma Patients
55.8.1 Critical Points to Conversion
55.9 Technical Aspects of SELT Procedure
55.9.1 Ready Check list Description
55.10 Summary
References
56: Esophageal Non-traumatic Emergencies
56.1 Introduction
56.1.1 Anatomy
56.1.2 Background
56.2 Clinical Presentation and Diagnosis
56.2.1 Esophageal Perforation
56.2.2 Foreign Body Ingestion
56.2.3 Complications of Esophageal Surgery
56.2.4 Descending Necrotizing Mediastinitis
56.2.5 Esophageal Bleeding
56.3 Treatment
56.3.1 Perforations
56.3.2 Foreign Body Ingestion
56.3.3 Complications of Esophageal Surgery
56.3.4 Descending Necrotizing Mediastinitis
56.3.5 Esophageal Bleeding
References
Further Reading
57: Esophageal Trauma
57.1 Introduction
57.1.1 Epidemiology and Etiology
57.1.2 Classification
57.2 Diagnosis
57.2.1 Clinical Presentation and Investigations
57.3 Medical Treatment
57.4 Surgical Treatment
References
58: Caustic Ingestion
58.1 Introduction
58.2 Epidemiology
58.3 Corrosive Agents
58.4 Emergency Management
58.4.1 Prehospital Management
58.4.2 In Hospital Management
58.4.3 Evaluation of Digestive Caustic Injuries
58.4.3.1 Symptoms
58.4.3.2 Laboratory Studies
58.4.3.3 Computed Tomography
58.4.3.4 Endoscopy
58.4.4 Injury Directed Management
58.4.4.1 Non-operative Treatment
58.4.4.2 Emergency Surgery
Oesophagogastrectomy (OGT)
Gastrectomy
Extended Resections
Tracheobronchial Necrosis (TBN)
Results of Emergency Surgery
58.5 Conclusion
References
59: Surgical Jaundice and Cholangitis
59.1 Introduction
59.1.1 Epidemiology
59.1.2 Etiology
59.1.3 Classification
59.1.4 Pathophysiology
59.2 Diagnosis
59.2.1 Clinical Presentation
59.2.2 Tests
59.3 Treatment
59.3.1 Medical Treatment
59.3.1.1 Cardiopulmonary
59.3.1.2 Renal
59.3.1.3 Nutrition
59.3.1.4 Coagulation
59.3.1.5 Grade I (Mild Acute Cholangitis)
59.3.1.6 Grade II (Moderate Acute Cholangitis)
59.3.1.7 Grade III (Severe Acute Cholangitis)
59.3.2 Surgical Treatment
59.3.3 Prognosis
References
Further Reading
60: Biliary Colic and Acute Cholecystitis
60.1 Introduction
60.1.1 Epidemiology
60.1.2 Etiology
60.1.3 Classification
60.1.4 Pathophysiology
60.2 Diagnosis
60.2.1 Clinical Presentation
60.2.2 Tests
60.2.3 Diagnostic Criteria
60.3 Treatment
60.3.1 Biliary Colic
60.3.2 Acute Cholecystitis
60.3.3 Common Bile Duct Stones Associated with Acute Cholecystitis
References
Further Reading
61: Hepatic Abscesses
61.1 Introduction
61.1.1 Epidemiology
61.1.2 Etiology
61.1.3 Classification
61.1.4 Pathophysiology
61.2 Diagnosis
61.2.1 Clinical Presentation
61.2.2 Tests
61.3 Treatment
61.3.1 Medical Treatment
61.3.2 Surgical Treatment
61.3.3 Prognosis
References
Further Reading
62: Spleen Non-traumatic Acute Surgical Conditions
62.1 Splenic Abscess
62.1.1 Epidemiology
62.1.2 Etiology
62.1.3 Classification
62.1.4 Pathophysiology
62.1.5 Diagnosis
62.1.5.1 Clinical Presentation
62.1.5.2 Tests
62.1.6 Treatment
62.1.6.1 Medical Treatment
62.1.6.2 Surgical Treatment
62.1.6.3 Prognosis
62.2 Atraumatic/Pathologic Splenic Rupture
62.2.1 Epidemiology
62.2.2 Etiology and Pathophysiology
62.2.3 Classification
62.2.4 Diagnosis
62.2.4.1 Clinical Presentation
62.2.4.2 Tests
62.2.5 Treatment
62.2.5.1 Medical Treatment
62.2.5.2 Surgical Treatment
62.2.5.3 Prognosis
62.3 Splenic Artery Aneurism
62.4 Postsplenectomy Management
References
Further Reading
63: Acute Adrenal Conditions: Pheochromocytoma Emergencies
63.1 Introduction
63.1.1 Epidemiology
63.1.2 Etiology
63.1.3 Classification
63.1.4 Pathophysiology
63.2 Diagnosis
63.2.1 Clinical Presentation
63.2.1.1 Multisystemic Failure
63.2.1.2 Hypertensive Crisis
63.2.1.3 Hypotension and Cardiogenic Shock
63.2.1.4 Arrhythmias
63.2.1.5 Acute Coronary Syndrome
63.2.1.6 Myocarditis and Cardiomyopathy
63.2.1.7 Pulmonary Edema
63.2.1.8 Gastrointestinal, Nephrological, and Neurological Emergencies
63.2.2 Tests
63.2.2.1 Biochemical Tests
63.2.2.2 Imaging Studies
63.3 Treatment
63.3.1 Preoperative Management
63.3.2 Intra-Operative Management
63.3.3 Medical Treatment
63.3.4 Surgical Treatment
63.3.5 Prognosis
References
64: Nontraumatic Liver Hemorrhage
64.1 Introduction
64.1.1 Epidemiology
64.1.2 Etiology and Classification
64.2 Common Principles in Diagnosis and Management
64.2.1 Clinical Presentation
64.2.2 Laboratory Testing
64.2.3 Imaging
64.2.4 Management
64.3 Etiologies of NLH
64.3.1 Benign Hepatic Lesions
64.3.1.1 Hepatic Adenoma
64.3.1.2 Hepatic Cyst
64.3.1.3 Focal Nodular Hyperplasia (FNH)
64.3.1.4 Hemangioma
64.3.1.5 Nodular Regenerative Hyperplasia (NRH)
64.3.1.6 Biliary Cystadenoma
64.3.1.7 Angiomyolipoma (AMLs)
64.3.2 Malignant Hepatic Lesions
64.3.2.1 Hepatocellular Carcinoma (HCC)
64.3.2.2 Angiosarcoma
64.3.2.3 Epithelioid Hemangioendothelioma (EHE)
64.3.2.4 Hepatoblastoma
64.3.2.5 Rhabdoid Sarcoma
64.3.2.6 Metastatic Disease to the Liver
64.3.3 Vascular/Autoimmune/Connective Tissue
64.3.3.1 Peliosis Hepatis
64.3.3.2 Amyloidosis
64.3.3.3 Systemic Lupus Erythematosus (SLE)
64.3.3.4 Polyarteritis Nodosa and Other Vasculitides
64.3.4 Obstetric Hepatic Disease
64.3.4.1 Hemolysis, Elevated Liver Enzymes, and Low Platelets (HELLP) Syndrome
64.3.4.2 Acute Fatty Liver of Pregnancy
References
65: Acute Pancreatitis
65.1 Introduction
65.1.1 Epidemiology
65.1.2 Etiology
65.1.3 Classification
65.1.4 Pathophysiology
65.2 Diagnosis
65.2.1 Clinical Presentation
65.2.2 Tests
65.3 Treatment
65.3.1 Medical Treatment
65.3.2 Surgical Treatment
65.3.2.1 Infected Pancreatic Necrosis (IPN)
65.3.2.2 Disconnected Duct Syndrome (DDS)
65.3.2.3 Abdominal Compartment Syndrome (ACS)
65.3.2.4 Gastrointestinal Perforations and Fistulas
65.3.2.5 Gangrenous Cholecystitis
65.3.2.6 Acute Bleeding or Pseudoaneurysm
65.3.2.7 Gastric Outlet Obstruction (GAO)
65.3.3 Prognosis
65.3.3.1 Complications
65.3.4 Mortality
References
Further Reading
66: Acute Appendicitis
66.1 Introduction
66.1.1 Epidemiology
66.1.2 Etiology, Pathophysiology, and Classification
66.2 Diagnosis
66.2.1 Clinical Presentation, Tests, and Differential Diagnosis
66.2.2 Imaging
66.3 Treatment
66.3.1 Nonoperative
66.3.2 Surgical Treatment
66.3.3 Prognosis
References
Suggested Reading
67: Acute Left Colonic Diverticulitis
67.1 Introduction
67.2 Classifications
67.3 Diagnosis
67.4 Treatment of Uncomplicated ALCD
67.5 Treatment of Diverticular Abscess
67.6 Treatment of Diverticular Peritonitis
67.7 Conclusions
References
68: Acute Mesenteric Ischemia
68.1 Introduction
68.1.1 Epidemiology
68.1.2 Etiology and Classification
68.1.3 Pathophysiology
68.2 Diagnosis
68.2.1 Clinical Presentation
68.2.2 Tests
68.2.2.1 Laboratory Diagnosis
68.2.3 Imaging Techniques
68.3 Treatment
68.3.1 Therapeutic Approaches
68.3.2 Surgical Options
68.3.2.1 Surgical Approach to the Superior Mesenteric Artery (SMA)
68.3.2.2 SMA Grafting
68.3.2.3 Retrograde Stenting in Case of Atheromatous Ostial Disease
68.3.3 Endovascular Techniques
68.4 Diagnosis and Treatment of NOMI
68.4.1 Mesenteric Venous Thrombosis (MVT)
References
69: Upper Gastrointestinal Bleeding
69.1 Introduction
69.1.1 Epidemiology
69.1.2 Etiology
69.1.3 Classification
69.1.4 Pathophysiology
69.1.4.1 Peptic Ulcer Disease (PUD)
69.1.4.2 Mallory-Weiss Syndrome
69.1.4.3 Stress Gastritis
69.1.4.4 Variceal Bleeding
69.1.4.5 Other Causes of UGIB
69.2 Diagnosis
69.2.1 Clinical Presentation
69.2.2 Test
69.3 Treatment
69.3.1 Workup and Initial Treatment
69.3.1.1 Hemodynamic Assessment and Resuscitation
69.3.1.2 Blood Transfusion
69.3.1.3 Risk Assessment
69.3.2 Medical Treatment
69.3.2.1 Pre-endoscopic Medical Treatment
69.3.2.2 Endoscopy
69.3.2.3 Interventional Radiology
69.3.3 Surgical Treatment
69.3.4 Follow-Up
References
Further Reading
70: Gastric Outlet Obstruction
70.1 Introduction
70.1.1 Epidemiology
70.1.2 Etiology
70.1.2.1 Mechanical Obstruction (Table 70.1)
70.1.2.2 Motility Disorders (Table 70.2)
70.1.2.3 Congenital Malformation (Table 70.2)
70.1.3 Classification
70.1.4 Pathophysiology
70.2 Diagnosis
70.2.1 Clinical Presentation
70.2.2 Tests
70.2.2.1 Laboratory Test
70.2.2.2 Imaging
70.2.2.3 Endoscopy
70.3 Treatment
70.3.1 Medical Treatment
70.3.1.1 Endoscopic Balloon Dilation (EBD)
70.3.1.2 Self-Expanding Metal Stents (SEMS)
70.3.1.3 Lumen-Apposing Metal Stents (LAMS)
70.3.2 Surgical Treatment
70.3.3 Chinese Medicine Treatment: Acupuncture
70.3.4 Prognosis
References
71: Acute Lower Gastrointestinal Bleeding
71.1 Introduction
71.1.1 Aetiology of Lower GI Bleeding
71.2 Diagnosis
71.2.1 Clinical Presentation and History Taking
71.2.2 Initial Investigation
71.3 Treatment
71.3.1 Medical Treatment
71.3.1.1 Blood Transfusion and Correction of Coagulopathy
71.3.1.2 Tranexamic Acid (TXA)
71.3.1.3 Anticoagulation and Antiplatelet Medications
71.3.1.4 Warfarin
71.3.1.5 Direct Oral Anticoagulants (DOAC)
71.3.1.6 Aspirin
71.3.1.7 Dual Antiplatelet Therapy (DAPT)
71.3.1.8 Management Algorithm and Severity Stratification
71.3.1.9 Risk Scoring Systems in Lower GI Bleeding
The Oakland Score
The Birmingham Score
71.3.1.10 Investigations and Treatments
71.3.1.11 Upper GI Endoscopy
71.3.2 Radiology
71.3.2.1 Computer Tomography Angiography (CTA)
71.3.2.2 Role of Interventional Radiology
71.3.2.3 Nuclear Scintigraphy
71.3.2.4 Video Capsule Endoscopy (VCE) and Small Bowel Enteroscopy
71.3.2.5 Lower GI Endoscopy
71.3.3 Surgical Treatment
71.3.4 Damage Control Surgery
71.4 Summary of Management
References
Further Reading
72: Perforated Peptic Ulcer
72.1 Introduction
72.1.1 Epidemiology
72.1.2 Etiology
72.1.2.1 Helicobacter pylori
72.1.2.2 Nonsteroidal Anti-inflammatory Drugs
72.1.2.3 Cigarette Smoking
72.1.2.4 Marginal Ulcer
72.1.3 Pathogenesis
72.2 Diagnosis
72.2.1 Clinical Presentation
72.2.2 Investigations
72.2.2.1 Serum Investigations
72.2.2.2 Imaging
72.3 Management
72.3.1 Resuscitation
72.3.2 Scoring Systems in PPU
72.3.3 Surgical Treatment
72.3.3.1 Open Surgery
72.3.3.2 Laparoscopic Surgery
72.3.3.3 Endoscopic Interventions
72.3.4 Nonoperative Management
72.3.5 Prognosis
References
Further Reading
73: Diagnosis and Management of Acute Small Bowel Obstruction
73.1 Introduction
73.1.1 Epidemiology
73.1.2 Etiology
73.1.2.1 Etiology in the Virgin Abdomen
73.1.3 Classification
73.2 Diagnosis
73.2.1 Clinical Presentation
73.2.2 Investigations and Imaging
73.3 Treatment
73.3.1 Non-operative Treatment
73.3.2 Surgical Treatment
73.3.3 Prognosis
References
Further Reading
74: Small Bowel Perforation
74.1 Introduction
74.1.1 Epidemiology
74.1.2 Aetiology
74.1.3 Classification
74.1.4 Pathophysiology
74.2 Diagnosis
74.2.1 Clinical Presentation
74.2.2 Tests
74.3 Treatment
74.3.1 Medical Treatment
74.3.2 Surgical Treatment
74.3.3 Prognosis
References
75: Small Bowel Diverticular Disease
75.1 Introduction
75.1.1 Epidemiology
75.1.2 Etiology
75.1.3 Classification
75.1.4 Pathophysiology
75.2 Diagnosis
75.2.1 Clinical Presentation
75.2.2 Tests
75.2.2.1 Labs
75.2.2.2 Conventional Radiology
75.2.2.3 Ultrasound (US)
75.2.2.4 MDCT Scans
75.2.2.5 MRI Findings
75.2.2.6 Scintigraphy
75.3 Treatment
75.3.1 Medical Treatment
75.3.1.1 Percutaneous Drainage
75.3.2 Surgical Treatment
75.3.3 Prognosis
References
76: Large Bowel Obstruction
76.1 Introduction
76.2 Diagnosis
76.3 Management
References
Further Reading
77: Large Bowel Perforation
77.1 Introduction
77.1.1 Epidemiology
77.1.2 Etiology
77.1.3 Classification (Table 77.1)
77.2 Diagnosis
77.2.1 Clinical Presentation
77.2.2 Tests
77.3 Treatment
77.3.1 Medical Treatment
77.3.2 Surgical Treatment
77.3.2.1 Non-traumatic Perforations
Colorectal Cancer
Ischemic Colitis
Ulcerative Colitis
77.3.2.2 Stercoral Perforations
77.3.2.3 Traumatic Perforations
References
Further Reading
78: Emergency Management of Abdominal Wall Hernia
78.1 Introduction
78.1.1 The (Societal) Problem of Abdominal Wall Hernia
78.1.2 Classification
78.1.2.1 Incarcerated and Strangulated Hernias
78.1.3 Etiology and Hernia Risk Factors
78.2 Diagnosis
78.2.1 Clinical Presentation
78.2.2 Diagnostics
78.3 Treatment
78.3.1 Medical Treatment
78.3.2 Surgical Treatment
78.3.2.1 Timing and Access
78.3.2.2 Use of Mesh
78.3.2.3 Preoperative Preparation
78.3.3 Prognosis
References
Further Reading
79: Emergency Management of Internal Hernia
79.1 Introduction
79.2 Epidemiology
79.3 Etiology
79.4 Pathophysiology
79.5 Classification and Types
79.6 Diagnosis
79.6.1 Clinical Presentation
79.6.2 Diagnostic Studies
79.7 Treatment
79.7.1 Medical Treatment
79.7.2 Surgical Treatment
79.7.3 Prognosis
References
80: Emergency Management Hiatal Hernia and Gastric Volvulus
80.1 Introduction
80.2 Paraesophageal Hernia
80.2.1 Classification
80.2.2 Clinical Presentation and Diagnosis
80.3 Gastric Volvulus
80.3.1 Etiology
80.3.2 Classification
80.3.3 Clinical Picture
80.4 Treatment
80.4.1 Preoperative Management
80.4.2 Endoscopic Therapy
80.4.3 Anterior Abdominal Wall Gastropexy
80.4.4 Laparoscopy Gastropexy
80.4.5 Laparoscopic Sutured Gastropexy
80.5 Surgery for Gastric Volvulus with Paraesophageal Hernia
80.5.1 Open Surgery
80.5.2 Laparoscopy Surgery
80.5.3 Postoperative Management
80.6 Conclusion
References
Further Reading
81: Stoma-Related Surgical Emergencies
81.1 Introduction
81.2 Diagnosis and Treatment
81.3 Early Complications Needing for Emergency Surgery
81.3.1 Evisceration
81.3.2 Ischemia and Stoma Necrosis
81.3.3 Bleeding
81.3.4 Stoma Retraction
81.3.5 Parastomal Infection
81.3.6 Mucocutaneous Separation
81.3.7 Early Obstruction
81.4 Late Complications Requiring Emergency Surgery
81.4.1 Parastomal Hernias
81.4.2 Stoma Prolapse
81.4.3 Stoma Stenosis
81.4.4 Stoma Fistula
81.4.5 Intestinal Obstruction in the Late Period
81.5 Conclusion
References
82: Inflammatory Bowel Disease
82.1 Introduction
82.2 Diagnosis
82.2.1 Clinical Presentation
82.2.2 Diagnostic Management
82.3 Treatment
82.3.1 Medical Treatment
82.3.2 Indications for Emergency Surgery
82.3.2.1 Acute Severe Colitis
82.3.2.2 Toxic Megacolon
82.3.2.3 Bowel Obstruction
82.3.2.4 Gastrointestinal Hemorrhage
82.3.2.5 Penetrating Crohn’s Disease
Perianal Disease
Intra-abdominal Fistula, Abscess, and Perforation
Enterocutaneous Fistula
82.3.2.6 Appendicitis in Patients with Inflammatory Bowel Disease
82.3.3 Basic Principles of Emergency Surgery for Inflammatory Bowel Disease
82.3.3.1 Principles of Emergency Surgery for Crohn’s Disease
82.3.3.2 Principles of Emergency Surgery for Ulcerative Colitis
82.3.3.3 Prevention of Venous Thromboembolism
82.3.3.4 Risk of Colorectal Cancer
References
Further Reading
83: Fulminant/Toxic Colitis
83.1 Introduction
83.1.1 Epidemiology
83.1.2 Etiology
83.1.3 Classification
83.1.4 Pathophysiology
83.2 Diagnosis
83.2.1 Clinical Presentation
83.2.2 Tests
83.2.2.1 Laboratory Investigations
83.2.2.2 Imaging
83.2.2.3 Endoscopy
83.3 Treatment
83.3.1 Medical Treatment
83.3.2 Surgical Treatment
83.3.3 Prognosis
References
Further Reading
84: Clostridium Infections
84.1 Introduction
84.1.1 Healthcare-Associated CDI (HCA-CDI)
84.1.2 Community-Associated (CA-) CDI
84.1.3 Indeterminate and Unknown CDI
84.1.4 Pediatric Setting
84.2 Epidemiology
84.3 027 Ribotype
84.4 Risk Factors
84.4.1 Host Predisposing Factors
84.4.2 Exposure to Spores
84.4.3 Colonic Microbiome Disruption
84.4.4 Antibiotic Exposure
84.4.5 Other Medications
84.4.6 Surgery
84.4.7 Risk Factors for CA-CDI
84.5 Clinical Features
84.5.1 Asymptomatic Patients
84.5.2 Mild-to-Moderate CDI
84.5.3 Severe CDI
84.5.4 Fulminant CDI
84.5.5 Toxic Megacolon
84.5.6 Cure
84.6 Mechanism of Action
84.7 Toxins
84.8 Recurrences
84.9 Diagnosis
84.9.1 Glutamate Dehydrogenase (GDH)
84.9.2 Toxins
84.9.3 Nucleic Acid Amplification Tests (NAATs)
84.9.4 Culture
84.9.5 Best Diagnostic Method: Algorithm
84.9.6 Other Diagnostic Methods
84.9.7 Radiological Diagnostic Imaging
84.9.8 Endoscopy
84.9.9 Laboratory Tests
84.9.10 Diagnosis in Pediatric Setting
84.10 Antibiotic Therapy
84.10.1 Metronidazole
84.10.2 Vancomycin
84.10.3 Fidaxomicin
84.10.4 Treatment
84.10.5 Other Options
84.10.6 Newer Antibiotics
84.10.7 Treatment of Recurrences
84.11 Monoclonal Antibodies
84.12 Fecal Transplantation
84.13 Other Possible Therapies
84.13.1 Supportive Care
84.13.2 Probiotics
84.13.3 Intravenous Immunoglobulin
84.13.4 Antimotility Agents
84.14 Surgical Management
84.15 Stewardship and Infection Control
84.15.1 Antibiotic Stewardship
84.15.2 Contact Precautions
84.15.3 Hand Hygiene and Barrier Precautions (Gloves and Gowns)
84.15.4 Environmental Cleaning
84.15.5 Screening of Asymptomatic Patients
84.15.6 Open Issues
References
85: Bowel Parasitic Surgical Emergencies
85.1 Introduction
85.1.1 Epidemiology
85.1.2 Etiology
85.1.3 Physiopathology
85.2 Diagnosis
85.2.1 Clinical Presentation
85.2.2 Tests
85.2.2.1 Biology
85.2.2.2 Imaging
85.2.2.3 Endoscopy
85.2.3 Final Diagnosis
85.3 Treatment
85.3.1 Medical Treatment
85.3.1.1 Drugs
85.3.1.2 Endoscopy
85.3.2 Surgical Treatment
85.3.2.1 Principles
85.3.2.2 Indications
85.3.3 Prognosis
References
Further Reading
86: Anorectal Emergencies
86.1 Introduction
86.1.1 Classification
86.2 Anorectal Abscess
86.2.1 Epidemiology
86.2.2 Etiology
86.2.3 Pathophysiology
86.2.4 Diagnosis
86.2.4.1 Clinical Presentation
86.2.4.2 Tests
86.2.5 Treatment
86.2.5.1 Medical Treatment
86.2.5.2 Surgical Treatment
86.2.6 Prognosis
86.3 Perineal Necrotizing Fasciitis (Fournier’s Gangrene)
86.3.1 Epidemiology
86.3.2 Etiology
86.3.3 Pathophysiology
86.3.4 Diagnosis
86.3.4.1 Clinical Presentation
86.3.4.2 Tests
86.3.5 Treatment
86.3.5.1 Medical Treatment
86.3.5.2 Surgical Treatment
86.3.6 Prognosis
86.4 Complicated Hemorrhoid (Thrombosed, Strangulated, or Bleeding)
86.4.1 Epidemiology
86.4.2 Etiology
86.4.3 Pathophysiology
86.4.4 Diagnosis
86.4.4.1 Clinical Presentation
86.4.4.2 Tests
86.4.5 Treatment
86.4.5.1 Medical Treatment
86.4.5.2 Surgical Treatment
86.4.6 Prognosis
86.5 Bleeding Anorectal Varices
86.5.1 Epidemiology
86.5.2 Etiology
86.5.3 Pathophysiology
86.5.4 Diagnosis
86.5.4.1 Clinical Presentation
86.5.4.2 Tests
86.5.5 Treatment
86.5.5.1 Medical Treatment
86.5.5.2 Surgical Treatment
86.5.6 Prognosis
86.6 Complicated Rectal Prolapse (Irreducible or Strangulated)
86.6.1 Epidemiology
86.6.2 Etiology
86.6.3 Pathophysiology
86.6.4 Diagnosis
86.6.4.1 Clinical Presentation
86.6.4.2 Tests
86.6.5 Treatment
86.6.5.1 Medical Treatment
86.6.5.2 Surgical Treatment
86.6.6 Prognosis
86.7 Retained Anorectal Foreign Bodies
86.7.1 Epidemiology
86.7.2 Etiology
86.7.3 Pathophysiology
86.7.4 Diagnosis
86.7.4.1 Clinical Presentation
86.7.4.2 Tests
86.7.5 Treatment
86.7.5.1 Medical Treatment
86.7.5.2 Surgical Treatment
86.7.6 Prognosis
86.8 Acute Anal Fissure
86.8.1 Epidemiology
86.8.2 Etiology
86.8.3 Pathophysiology
86.8.4 Diagnosis
86.8.4.1 Clinical Presentation
86.8.4.2 Tests
86.8.5 Treatment
86.8.5.1 Medical Treatment
86.8.5.2 Surgical Treatment
86.8.6 Prognosis
References
Further Reading
87: Gynaecological Surgical Emergencies
87.1 Introduction
87.2 Ectopic Pregnancy
87.2.1 Introduction
87.2.2 Diagnosis
87.2.3 Management
87.3 Adnexal Torsion
87.3.1 Introduction
87.3.2 Diagnosis
87.3.3 Management
87.4 PID and Tubo-Ovarian Abscess
87.4.1 Introduction
87.4.2 Diagnosis
87.4.3 Management
87.5 Female Non-obstetric Genital Injuries
87.6 Unsafe Abortions
References
88: Nontraumatic Urologic Emergencies
88.1 Introduction
88.2 Penile Emergencies (Table 88.1)
88.2.1 Priapism
88.2.2 Classification and Pathophysiology
88.2.3 Diagnosis
88.2.4 Treatment (Medical)
88.2.4.1 Ischemic (Low Flow) Priapism
88.2.4.2 Stuttering Priapism
88.2.4.3 Nonischemic (Arterial, High-Flow) Priapism
88.2.5 Prognosis
88.3 Penile Ring Entrapment
88.3.1 Paraphimosis
88.3.2 Prognosis
88.4 Nontraumatic Scrotal Emergencies
88.4.1 Testicular Torsion
88.4.1.1 Epidemiology
88.4.1.2 Etiology
88.4.1.3 Pathophysiology
88.4.2 Diagnosis
88.4.2.1 Clinical Presentation
88.4.2.2 Imaging
88.4.2.3 Treatment (Surgical)
88.4.2.4 Prognosis
88.5 Fournier Gangrene
88.5.1 Epidemiology
88.5.2 Etiology
88.5.3 Pathophysiology
88.5.4 Diagnosis and Clinical Presentation
88.5.5 Tests
88.5.6 Treatment
88.5.7 Prognosis
88.6 Obstructing Nephrolithiasis
88.6.1 Epidemiology
88.6.2 Etiology
88.6.3 Pathophysiology
88.6.4 Diagnosis
88.6.4.1 Clinical Presentation
88.6.4.2 Laboratory Tests
88.6.4.3 Medical Treatment
88.6.4.4 Surgical Treatment
88.6.5 Prognosis
88.7 Acute Urinary Retention (AUR)
88.7.1 Epidemiology
88.7.2 Etiology
88.7.3 Classification
88.7.4 Pathophysiology
88.7.5 Diagnosis and Clinical Presentation
88.7.6 Clinical Presentation
88.7.7 Tests
88.7.8 Treatment
88.7.8.1 Medical Treatment
88.7.8.2 Surgical Treatment
88.7.9 Prognosis
References
89: Non-Obstetric Abdominal Surgical Emergencies in Pregnancy and Puerperium
89.1 Background
89.1.1 Epidemiology
89.1.2 Etiology
89.1.3 Pathophysiology
89.2 Diagnosis
89.2.1 Acute Appendicitis
89.2.1.1 Clinical Presentation
89.2.1.2 Tests
89.2.2 Acute Biliary Disease
89.2.2.1 Clinical Presentation
89.2.2.2 Tests
89.2.3 Acute Pancreatitis
89.2.3.1 Clinical Presentation
89.2.3.2 Tests
89.2.4 Symptomatic Abdominal Wall Hernias
89.2.4.1 Clinical Presentation
89.2.4.2 Tests
89.2.5 Intestinal Obstruction
89.2.5.1 Clinical Presentation
Plain Abdominal X-Rays
89.2.5.2 Transabdominal Ultrasound
89.2.6 Maternal Abdominal Trauma
89.2.6.1 Blunt Abdominal Trauma
89.2.6.2 Penetrating Abdominal Trauma
89.2.6.3 Fetomaternal Hemorrhage
89.2.6.4 Amniotic Fluid Embolism
89.2.6.5 Laboratory Findings
89.2.6.6 Plain Abdominal X-Rays
89.2.6.7 Transabdominal Ultrasound
89.2.6.8 Abdominal CT
89.3 Treatment
89.3.1 Acute Appendicitis
89.3.1.1 Medical Treatment
89.3.1.2 Surgical Treatment
89.3.1.3 Prognosis
89.3.2 Acute Biliary Disease
89.3.2.1 Medical Treatment
89.3.2.2 Surgical Treatment
89.3.2.3 Prognosis
89.3.3 Acute Pancreatitis
89.3.3.1 Medical Treatment
89.3.3.2 Surgical Treatment
89.3.3.3 Prognosis
89.3.4 Symptomatic Abdominal Wall Hernia
89.3.4.1 Medical Treatment
89.3.4.2 Surgical Treatment
89.3.4.3 Prognosis
89.3.5 Intestinal Obstruction
89.3.5.1 Medical Treatment
89.3.5.2 Surgical Treatment
89.3.5.3 Prognosis
89.3.6 Maternal Abdominal Trauma
89.3.6.1 Prehospital Treatment
89.3.6.2 Observation
89.3.6.3 Interventional Radiology
89.3.7 Surgical Treatment Blunt Trauma
89.3.7.1 Surgical Treatment Penetrating Trauma
89.3.8 Obstetric Treatment
89.3.9 Prognosis Blunt Abdominal Trauma
89.3.9.1 Prognosis Penetrating Abdominal Trauma
References
90: Enterovesical and Enterogenital Fistulae
90.1 Introduction
90.1.1 History and Classification
90.1.2 Aetiology
90.1.3 Epidemiology
90.1.4 Pathophysiology
90.1.4.1 Inflammatory
90.1.4.2 Malignant
90.1.4.3 Iatrogenic
90.1.4.4 Trauma
90.2 Diagnosis
90.2.1 Clinical Presentation
90.2.2 Tests
90.3 Treatment
90.3.1 Medical Treatment
90.3.2 Surgical Treatment
90.3.3 Prognosis
References
Further Reading
91: Enterocutaneous and Enteroatmospheric Fistulae
91.1 Introduction
91.1.1 Definitions
91.1.2 Epidemiology
91.1.3 Aetiology
91.1.3.1 Aetiology—Iatrogenic ECFs and EAFs
91.1.3.2 Aetiology—Spontaneous ECFs
91.1.4 Classification
91.2 Diagnosis
91.2.1 Clinical Presentation
91.2.1.1 History
91.2.1.2 Examination
91.2.2 Tests
91.2.2.1 Identifying Associated Abdominal Pathology
91.2.2.2 Defining the Anatomy of an ECF
91.2.2.3 Investigations for the Sequelae of ECF and EAF
91.2.2.4 Investigations to Plan Definitive Closure of ECFs and EAFs
91.3 Treatment
91.3.1 Principles of Treatment
91.3.2 Medical Treatment
91.3.2.1 Wound Management
91.3.2.2 Treating Sepsis
91.3.2.3 Measures to Reduce Fistula Output
91.3.2.4 Optimizing Nutritional Status
91.3.2.5 Fibrin Sealant and Glue Closure of the Fistula
91.3.2.6 Novel Methods in Wound Management and Surgical Control of ECFs and EAFs
91.3.3 Surgical Treatment
References
Further Reading
92: Complication of Bariatric Surgery
92.1 Introduction
92.1.1 Epidemiology
92.1.2 Etiology
92.1.2.1 Types of Bariatric Surgery
92.1.2.2 Sleeve Gastrectomy (SG)
92.1.2.3 Roux-En-Y Gastric Bypass (RYGB)
92.1.2.4 Omega Anastomosis Gastric Bypass/Mini Gastric Bypass (OAGB/MGB)
92.1.2.5 Adjustable Gastric Banding (AGB)
92.1.2.6 Other Bariatric Procedures
92.1.3 Classification
92.1.4 Pathophysiology
92.1.4.1 Nonsurgical Complications
92.1.4.2 Surgical Complications
Bleeding
General
Sleeve Gastrectomy
Roux-En-Y Gastric Bypass and Omega Anastomosis Gastric Bypass/Mini Gastric Bypass
Obstruction
General
Sleeve Gastrectomy
Roux-En-Y Gastric Bypass
Omega Anastomosis Gastric Bypass/Mini Gastric Bypass
Adjustable Gastric Banding
Systemic Inflammatory Response Syndrome (SIRS)/Sepsis
Roux-En-Y Gastric Bypass and Omega Anastomosis Gastric Bypass/Mini Gastric Bypass
Adjustable Gastric Banding
Abdominal Pain/Discomfort
92.2 Diagnosis
92.2.1 Clinical Presentation
92.2.1.1 Airway
92.2.1.2 Breathing
92.2.1.3 Circulation
92.2.1.4 History
92.2.1.5 Physical Examination
92.2.2 Tests
92.2.2.1 Laboratory Tests
92.2.2.2 Imaging Studies
X-Ray
Upper Gastrointestinal Contrast Swallow Test
92.2.2.3 Computed Tomography (CT)
92.2.2.4 Endoscopy
92.2.2.5 Ultrasound (US)
92.3 Treatment
92.3.1 Medical Treatment
92.3.1.1 Bleeding
92.3.1.2 Obstruction
92.3.1.3 Systemic Inflammatory Response Syndrome (SIRS)/Sepsis
92.3.2 Surgical Treatment
92.3.3 Prognosis
References
Further Reading
93: Intra-Abdominal Hypertension and Abdominal Compartment Syndrome
93.1 Introduction
93.1.1 History of IAH and ACS
93.1.2 Normal IAP
93.1.3 IAH and ACS
93.1.4 Epidemiology
93.1.5 Pathophysiology
93.1.6 Systemic Effects of IAH/ACS
93.1.7 Neurological
93.1.8 Cardiovascular
93.1.9 Respiratory
93.1.10 Renal
93.1.11 Gastrointestinal
93.2 Diagnosis
93.2.1 When Should IAP Be Measured?
93.2.2 How Should IAP Be Measured?
93.2.3 Clinical Signs
93.3 Treatment
93.3.1 Medical Management
93.3.2 Interventional Management
93.3.3 Surgical Management
93.3.4 Prevention of IAH/ACS
93.3.5 Surgical Decompression
93.3.6 TAC
93.3.7 Wound Management and Complications
93.3.8 Abdominal Reconstruction
93.3.9 Prognosis
93.4 Conclusions
References
94: Open Abdomen Management
94.1 Introduction
94.2 Aetiology
94.2.1 Traumatic Intra-Abdominal Bleeding
94.2.2 Intra-Abdominal Sepsis
94.2.3 Indications for OA: Trauma
94.2.4 Indications for OA: Non-Trauma
94.3 Diagnosis
94.4 Treatment
94.4.1 Temporary Abdominal Closure Techniques
94.4.2 Complications
94.4.2.1 Enteroatmospheric Fistula
94.4.2.2 Delayed Fascial Closure
94.4.2.3 Incisional Ventral Hernias
References
Further Reading
95: Liver Trauma
95.1 Introduction
95.1.1 Epidemiology
95.1.2 Etiology: Mechanism of Injury
95.2 Classification
95.3 Diagnosis of Liver Trauma
95.4 Management Strategies
95.5 Non-Operative Management (NOM) of Liver Injury
95.5.1 NOM in Penetrating Trauma
95.5.2 Concomitant Neurotrauma
95.5.3 Role of Laparoscopy
95.6 Operative Management (OM)
95.6.1 Specific Considerations
95.7 Complications
95.8 Thrombo-Prophylaxis, Feeding, and Mobilization
95.9 Follow-Up
References
Further Reading
96: Splenic Trauma
96.1 Introduction
96.2 Epidemiology
96.3 Etiology
96.4 Classification
96.5 Diagnosis
96.5.1 Clinical Presentation
96.5.2 Diagnostic Imaging
96.6 Management
96.6.1 Nonoperative Management (NOM) for Blunt Splenic Trauma
96.6.2 Nonoperative Management (NOM) for Penetrating Trauma
96.6.3 Role of Angiography and Angioembolization [AG/AE] in NOM
96.6.4 Operative Management (OM)
96.6.5 Thromboprophylaxis in Splenic Trauma
96.7 Prognosis: Short- and Long-Term Follow-up for NOM
96.8 Pediatric Splenic Trauma (<15 Years Old)
96.8.1 Diagnostic Procedures
96.8.2 Nonoperative Management in Splenic Injury
96.8.3 The Role of Angiography/Angioembolization (AG/AE)
96.8.4 Operative Management in Blunt and Penetrating Injuries
96.8.5 Splenic Trauma Associated with Head Injuries
96.8.6 Short- and Long-Term Follow-Up in Splenic Trauma (Blunt and Penetrating)
96.9 Infection Prophylaxis in Asplenic and Hyposplenic Adult and Pediatric Patients
References
Further Reading
97: Bowel Trauma
97.1 Introduction
97.2 Epidemiology
97.3 Classification
97.4 Diagnosis
97.4.1 Clinical Presentation
97.4.2 Initial Approach and Diagnosis
97.5 Treatment
97.6 Complications
97.7 Discussion
97.7.1 Indications for Damage Control Surgery (DCS)
97.7.2 Combined Small and Large Bowel Injuries
97.7.3 Hand-Sewn Versus Staple Technique
97.7.4 Abdominal Closure
97.8 Conclusion
References
98: Kidney and Urotrauma
98.1 Introduction
98.1.1 Epidemiology and Mechanism of Injury
98.1.1.1 Kidney
98.1.1.2 Ureter
98.1.1.3 Bladder
98.1.1.4 Urethra
98.1.2 Classification
98.1.2.1 Kidney
98.1.2.2 Urinary Tract
98.2 Diagnosis
98.2.1 Clinical Presentation
98.2.2 Diagnostic Procedures
98.2.2.1 Kidney
98.2.2.2 Pediatric Kidney Trauma
98.2.2.3 Ureter
98.2.2.4 Bladder
98.2.2.5 Urethra
98.3 Kidney Trauma: Management
98.3.1 Kidney: Nonoperative Management (NOM)
98.3.1.1 Angiography and/or Angioembolization (AG/AE)
98.3.2 Kidney Trauma: Operative Management
98.3.3 Renal Trauma Complications
98.4 Urinary Tract Injuries: Management
98.4.1 Ureteral Trauma
98.4.1.1 Ureteral Trauma Complications
98.4.2 Bladder Trauma
98.4.3 Urethral Trauma
98.4.3.1 Penetrating Injuries
Urethral Trauma Complications
98.5 Follow-Up
References
99: Duodeno-Pancreatic and Extrahepatic Biliary Trauma
99.1 Introduction
99.2 Epidemiology
99.3 Etiology
99.4 Classification
99.5 Diagnosis
99.6 Treatment
99.6.1 Nonoperative Management
99.6.2 Operative Management
99.7 Outcomes and Complications
References
Further Reading
100: Abdominal Vascular Trauma
100.1 Introduction
100.1.1 Epidemiology
100.2 Diagnosis
100.2.1 Clinical Presentation
100.2.2 Tests
100.3 Treatment
100.3.1 Nonoperative Management (NOM)
100.3.2 Open Surgical Treatment
100.3.2.1 Aorta
100.3.2.2 IVC
100.3.2.3 Celiac Artery
100.3.2.4 SMA
100.3.2.5 IMA
100.3.2.6 PV/SMV
100.3.2.7 Renal Arteries/Veins
100.3.2.8 Iliac Arteries/Veins
100.3.3 Prognosis
References
Further Reading
101: Genital and Anorectal Trauma
101.1 Introduction: Epidemiology and Background Information
101.2 Anatomy of the Anorectal and Genital Structures
101.3 Injury to the Male External Genitalia: Blunt and Penetrating (See Flowchart 101.1—Penetrating)
101.4 Injury to the Female External Genitalia (See Also Flowchart 101.1 for General Approach)
101.5 Injury to the Nongravid Uterus
101.6 Injury to the Male Perineum and Anal Canal Due to Blunt Trauma
101.6.1 Penetrating Injury to the Rectum and Anus: Modern Evidence-Based Approaches (See Flowchart 101.2)
101.6.2 Male Proximal Urethral Injuries (See Flowchart 101.3)
References
Further Reading
102: Pelvic Trauma
102.1 Introduction
102.1.1 Epidemiology
102.1.2 Etiology
102.1.3 Classification
102.1.3.1 History of Pelvic Fracture Classification
102.1.3.2 The Young and Burgess Classification (1990)
102.1.3.3 The AO/OTA Classification (2018)
102.1.3.4 The WSES Classification (2017)
102.1.4 Pathophysiology
102.2 Diagnosis
102.2.1 Clinical Presentation
102.2.2 Tests
102.2.2.1 Laboratory Tests
102.2.2.2 Diagnostic Imaging
102.3 Treatment
102.3.1 Medical Treatment
102.3.1.1 Volume Resuscitation
102.3.1.2 Pelvic Binders
102.3.1.3 REBOA
102.3.1.4 Angioembolization
102.3.2 Surgical Treatment
102.3.2.1 External Pelvic Fixation
102.3.2.2 Pelvic Packing
102.3.3 Outcomes
References
103: Ruptured Abdominal Aortic Aneurysm (rAAA)
103.1 Introduction and Overview
103.1.1 Etiology and Epidemiology
103.1.2 Classifications and Mechanisms of AAA and rAAA
103.2 Diagnosis and Clinical Presentation of rAAA
103.3 Treatment of rAAA
103.3.1 Open Surgery
103.3.2 Endovascular Surgery
103.3.3 Complications
References
104: Visceral Artery Aneurysms
104.1 Introduction
104.1.1 Epidemiology
104.1.2 Etiology
104.1.3 Classification
104.1.4 Pathophysiology
104.2 Diagnosis
104.2.1 Clinical Presentation
104.2.2 Tests
104.3 Treatment
104.3.1 Medical Treatment
104.3.2 Surgical Treatment
104.3.2.1 SAAs
104.3.2.2 HAAs
104.3.2.3 CAAs
104.3.2.4 SMAAs
104.3.3 Prognosis
References
Further Reading
105: Management of Complications Occurring After Pancreas Transplantation
105.1 Introduction
105.2 Diagnosis and Indications to Pancreas Transplantation
105.3 Complications Occurring After Pancreas Transplantation
105.4 Surgical Techniques for Pancreas (and Kidney) Transplantation
105.5 Treatment and Management of Posttransplant Complications
105.5.1 Intestinal Complications
105.5.1.1 Duodenal Graft Perforation (DGP)
105.5.1.2 Intestinal Bleeding and Duodenal Graft Bleeding (DGB)
105.5.1.3 Intestinal Obstruction
105.5.2 Abdominal Fluid Collections
105.5.3 Vascular Complications
105.5.3.1 Vascular Thrombosis (VT)
105.5.3.2 Pseudoaneurysm
105.5.3.3 Artero-Venous Fistula
105.5.3.4 Arterio-Enteric Fistula
105.5.4 Complications Related to the Renal Graft
105.5.4.1 Renal Graft Thrombosis
105.5.4.2 Renal Graft Rupture
105.5.4.3 Urological Complications (Fistula, Ureteral Stenosis)
105.5.4.4 Lymphocele
105.5.5 Complications Non-related to the Transplant
105.6 Conclusions
References
Further Reading
106: Liver Transplant Complications Management
106.1 Introduction
106.2 Arterial Complications (Table 106.1)
106.2.1 Hepatic Arterial Thrombosis
106.2.1.1 Risk Factors for HAT
106.2.1.2 Clinical Manifestations
106.2.1.3 Diagnosis
106.2.1.4 Management
106.2.2 Hepatic Arterial Stenosis
106.2.2.1 Risk Factors
106.2.2.2 Clinical Manifestations
106.2.2.3 Diagnosis
106.2.2.4 Management
106.2.3 Hepatic Arterial Pseudoaneurysm
106.2.3.1 Risk Factors
106.2.3.2 Clinical Manifestations and Diagnosis
106.2.3.3 Management
106.3 Portal Vein Complications
106.3.1 Risk Factors
106.3.2 Clinical Manifestations
106.3.3 Diagnosis
106.3.4 Management
106.4 IVC and Hepatic Vein Complications
106.4.1 Risk Factors
106.4.2 Clinical Manifestations
106.4.3 Diagnosis
106.4.4 Management
106.5 Biliary Complications
106.5.1 Risk Factors
106.5.2 Diagnosis
106.5.3 Biliary Leaks
106.5.4 Biliary Strictures
106.5.5 Biliary Stones and Cast Syndrome
106.6 Other Rare Complications
106.7 Small-for-Size Syndrome
References
Further Reading
Part V: Extremities
107: Emergency Vascular Access to Extremities
107.1 Introduction
107.1.1 Early Lessons
107.1.2 Factors in Vascular Exposure
107.1.3 Preoperative Preparation and Adequate Exposure
107.1.4 Penetrating Trauma and Open Wounds
107.2 Upper Extremity Injuries
107.2.1 General Considerations
107.2.2 Anatomy
107.2.2.1 Great Vessels and Junctional Area
107.2.2.2 Subclavian Arteries
Origin
Portions and Branches
107.2.2.3 Subclavian Veins
Origin
107.2.2.4 Axillary Arteries
Origin
Portions and Branches
107.2.2.5 Brachial Arteries
Origin
Branches
107.2.2.6 Radial and Ulnar Arteries
Origin
Branches
107.2.3 Exposure
107.2.3.1 Great Vessels, Junctional Area, and Proximal Subclavian Arteries
Incisions
Median Sternotomy
Anterolateral Thoracotomy
Supraclavicular Incision
Infraclavicular Incision
107.2.3.2 Subclavian Veins
Incisions and Control
107.2.3.3 Axillary Artery and Proximal Brachial Artery
Incisions
107.2.3.4 Distal Brachial Artery and Bifurcation
Incisions
107.2.3.5 Radial and Ulnar Arteries
Incisions
107.3 Lower Extremities
107.3.1 General Considerations
107.3.1.1 The Junctional Area and Iliac Vessels
107.3.1.2 Femoral and Popliteal Vessels
107.3.1.3 Tibio-Peroneal Vessels
Anatomy
Iliac Arteries
Origin
Branches
Common, Superficial, and Deep Femoral Artery
Origin
Popliteal Artery
Origin
Branches
Exposure
General Considerations
Groin Incisions
Other Incisions
107.3.1.4 Common Iliac Vessels
107.3.1.5 External Iliac Vessels
Laparotomy for Other Reasons
Primary Exposure of External Iliac Vessels
107.3.1.6 Exposure of Femoral Vessels at the Groin
Incision
Further Exposure
107.3.1.7 Exposure of the Distal Superficial Femoral Artery and Popliteal Vessels Above the Knee
Incision
Further Exposure
107.3.1.8 Exposure of the Popliteal Vessels Below the Knee
Incision
Posterior Approach
107.3.1.9 Exposure of the Tibial and Peroneal Vessels
Exposure of the Bifurcation and Trifurcation
Exposure of Anterior Tibial Artery
References
Further Reading
108: Extremity Vascular Injuries
108.1 Introduction
108.1.1 Epidemiology
108.1.2 Etiology
108.1.3 Classification
108.1.4 Pathophysiology
108.2 Diagnosis
108.2.1 Clinical Presentation and Physical Examination
108.2.2 Laboratory and Imaging Tests
108.2.2.1 Doppler Ultrasound (DUS)
108.2.2.2 Computed Tomography Angiography (CTA)
108.2.2.3 Conventional Angiography
108.3 Treatment
108.3.1 Medical Treatment
108.3.1.1 Endovascular Treatment
108.3.1.2 Anticoagulation
108.3.2 Surgical Treatment
108.3.2.1 General Considerations
108.3.2.2 Vascular Damage Control
108.3.2.3 Compartment Pressure Monitoring and Release
108.3.2.4 Upper Extremity Vascular Injuries
Axillary
Brachial and Radial/Ulnar
108.3.2.5 Lower Extremity Vascular Injuries
Femoral
Popliteal
Arteries Below the Knee
108.3.2.6 Venous Injuries
108.3.3 Prognoses, Outcomes, and Complications
References
Further Reading
109: Extremities Trauma
109.1 Introduction
109.1.1 Epidemiology
109.1.2 Classification
109.1.3 Pathophysiology
109.2 Diagnosis
109.2.1 Clinical Presentation
109.2.2 Tests
109.2.2.1 Radiological Examination
109.2.2.2 Laboratory Tests
109.3 Treatment
109.3.1 Surgical Treatment
109.3.1.1 Factures and Luxation
109.3.1.2 Amputation
109.3.1.3 Extremities Trauma in Multiple Injured Patients
109.3.2 Medical Treatment
109.3.3 Prognosis
References
Further Reading
110: Extremity Compartment Syndrome
110.1 Introduction
110.1.1 Epidemiology
110.1.2 Etiology
110.1.3 Classification
110.1.4 Pathophysiology
110.1.5 Surgical Anatomy
110.2 Diagnosis
110.2.1 Clinical Presentation
110.2.2 Investigations
110.2.2.1 Instructions for Measurement of the Different Anatomical Compartments
110.3 Treatment
110.3.1 Medical Treatment
110.3.2 Surgical Treatment
110.3.2.1 General Operative Principles
110.3.2.2 Upper Extremity Fasciotomy
110.3.2.3 Lower Extremity Fasciotomies
110.3.3 Prognosis
References
Further Reading
111: Fasciitis
111.1 Introduction
111.1.1 Epidemiology
111.1.2 Etiology
111.1.3 Classification
111.1.4 Pathophysiology
111.2 Diagnosis
111.2.1 Clinical Presentation
111.2.2 Test
111.3 Treatment
111.3.1 Surgical Treatment
111.3.2 Medical Treatment
111.3.3 Prognosis
References
Further Reading
112: Bone Infections
112.1 Introduction
112.1.1 Epidemiology
112.1.2 Etiology
112.1.3 Classification
112.1.4 Pathophysiology
112.2 Diagnosis
112.2.1 Clinical Presentation
112.2.2 Tests
112.3 Treatment
112.3.1 Medical Treatment
112.3.2 Surgical Treatment
112.3.3 Prognosis
References
Further Reading
Part VI: Soft Tissues
113: Necrotizing Soft Tissue Infection
113.1 Introduction
113.2 Etiology
113.3 Classification
113.3.1 Type I Infections
113.3.2 Type II Infections
113.3.3 Type III Infections
113.3.4 Type IV Infections
113.4 Diagnosis
113.4.1 History
113.4.2 Clinical Characteristics
113.4.3 Diagnostic Tools
113.4.4 Laboratory
113.4.5 Imaging
113.4.6 Macroscopic/Microscopic
113.5 Medical Treatment
113.5.1 Antibiotic Therapy
113.5.1.1 Duration
113.5.2 Surgical Treatment
113.5.2.1 Support
113.5.3 Adjunctive Therapy
113.5.3.1 Hyperbaric Oxygen
113.5.4 IVIG
113.6 Prognosis
References
Further Reading
114: Cutaneous and Subcutaneous Abscesses
114.1 Introduction
114.1.1 Epidemiology
114.1.2 Aetiology
114.1.3 Classification
114.1.4 Pathophysiology
114.2 Diagnosis
114.2.1 Clinical Manifestation
114.2.2 Laboratory Tests and Imaging
114.3 Therapy
114.3.1 Surgery
114.3.2 Antibiotic Therapy
114.3.3 Prognosis
References
Further Reading
115: Surgical Site Infections
115.1 Introduction
115.1.1 Epidemiology
115.1.2 Aetiology and Risk Factors
115.1.3 Classification
115.1.4 Pathophysiology
115.1.4.1 Physiology of Wound Healing
115.1.4.2 Pathogens in SSI
115.2 Diagnosis
115.2.1 Risk Prediction
115.2.2 Diagnostic Criteria
115.3 Prevention and Treatment
115.3.1 SSI Prevention
115.3.1.1 Peri-operative Care
Pre-operative Antibiotics
Peri-operative Normothermia
Glycaemic Control
Supplemental Oxygen
115.3.1.2 Surgical Strategies
Skin Preparation and Optimal Incision
Wound Protectors
Fascial Closure
Interrupted or Continuous Sutures
Absorbable or Non-absorbable Sutures
Coated Sutures
Skin Closure
Wound Washout and Topical Antibiotics
Staples or Sutures
Negative Pressure Wound Therapy (NPWT)
115.3.2 Treatment of SSI
115.3.2.1 Incisional SSI
115.3.2.2 Deep-Space SSI
References
Further Reading