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A CT scan is the preferred method of diagnosis; however, free air from a perforation can often be seen on plain X-ray. [2] Perforation anywhere along the gastrointestinal tract typically requires emergency surgery in the form of an exploratory laparotomy. [2] This is usually carried out along with intravenous fluids and antibiotics. [2]
Approximately 1 in 5 emergency surgeries are due to adhesive bowel obstruction. When possible this is managed without surgery with IV fluids, and NG tube to drain the stomach and intestines, and bowel rest (not eating) until the obstruction resolves. If signs of bowel ischemia or perforation are present then emergency surgery is required.
Non-gangrenous ischemic colitis, which comprises the vast majority of cases, is associated with a mortality rate of approximately 6%. [34] However, the minority of patients who develop gangrene as a result of colonic ischemia have a mortality rate of 50–75% with surgical treatment; the mortality rate is almost 100% without surgical ...
In small bowel obstruction about 25% require surgery. [6] Complications may include sepsis, bowel ischemia and bowel perforation. [1] About 3.2 million cases of bowel obstruction occurred in 2015 which resulted in 264,000 deaths. [3] [7] Both sexes are equally affected and the condition can occur at any age. [6]
a. Localized or generalized peritonitis caused by perforation of the bowel secondary to the cancer b. Viable but injured proximal bowel that, in the opinion of the operating surgeon, precludes safe anastomosis c. Complicated diverticulitis [2] Use of the Hartmann's procedure initially had a mortality rate of 8.8%. [3]
On physical exam, bowel sounds will be absent. Laboratory tests reveal a neutrophilic leukocytosis, sometimes with a left shift, and increased serum amylase. Abdominal radiography will show many air-fluid levels, as well as widespread edema. Acute ischemic abdomen is a surgical emergency.
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If appendicitis develops in a pregnant woman, an appendectomy is usually performed and should not harm the fetus. [15] The risk of premature delivery is about 10%. [16] The risk of fetal death in the perioperative period after an appendectomy for early acute appendicitis is 3 to 5%. The risk of fetal death is 20% in perforated appendicitis. [17]