Post-bariatric Complications—Leaks
Fig. 20.1 Leak demonstrated on UGI 2 weeks after laparoscopic sleeve gastrectomy Of note, many practices obtain routine UGI as part of postoperative algorithm for management, whether the patient is or is not…
The Problem Stoma
Fig. 21.1 Full-thickness ischemia of stoma While edema and venous engorgement in the immediate postoperative period is common, this was a case of stoma necrosis, which is one of the more…
Complex Liver Abscess
Abscess type Causative organism Patient population Treatment Pyogenic Polymicrobial (biliary and enteric organisms most likely); Klebsiella spp. increasing in incidence Recent biliary intervention; Multiple medical comorbid conditions; Immunocompromised Broad-spectrum antibiotics;…
Unresectable Malignancy and Bowel Obstruction in the Acute Care Surgery Patient
Small intestine Large intestine Proximal Distal Competent ileocecal valve Non-competent ileocecal valve Anorexia Present Variable Variable Variable Vomiting Present: bilious, large quantity, non-malodorous Usually present: feculent/particulate, small volume, foul…
Empyema in the Acute Care Surgical Patient
Fig. 7.1 A management algorithm for parapneumonic effusion. Reproduced with permission from Moore et al. [63, Fig. 1], with permission courtesy of Wolters Kluwer Health, Inc After tube placement, vigilant follow-up of…
Intra-abdominal Hypertension and Abdominal Compartment Syndrome in Acute Care Surgery
Organ system Pathophysiologic effects Clinical manifestations Threshold IAP (mmHg) Cardiovascular Decreased preload/venous return Increased afterload Compression of inferior vena cava Decreased cardiac output Increased susceptibility to hypovolemia 10 Pulmonary Increased…
The Relaparotomy in the Delayed (2–3 Week) Postoperative Period
© Springer International Publishing Switzerland 2017Jose J. Diaz and David T. Efron (eds.)Complications in Acute Care Surgery10.1007/978-3-319-42376-0_24 24. The Relaparotomy in the Delayed (2–3 Week) Postoperative Period Nicole Stassen1 and Michael Rotondo1 (1) Department of Surgery, University…
Colon: Long Hartmann and Rectal Stump Blowout
Pathophysiology Perioperative risk factors Antibiotics Appropriate perioperative antibiosis minimizes microbial burden, which limits inflammatory response and infection risk Blood supply Adequate blood flow is required for delivery of nutrients and…
Management of Anastomotic Leaks—Early <7 Days and Late >7 Days
Technical error Emergency surgery Prolonged operative time Blood loss Use of vasopressors Tension on anastomosis Suture line tension Poor blood supply Steroids Obesity Smoking Advanced age COPD Reoperative surgery Malnutrition…
The Immunosuppressed Patient
CD4 count (cell/ml) Opportunistic infection Primary regimen <250 Coccidioidomycosis Fluconazole/itraconazole <200 Pneumocystis pneumonia TMP-SMX Histoplasmosis Amphotericin B <150 H. capsulatum Itraconazole <100 T. gondii encephalitis Pyrimethamine Cryptococcal meningitis Amphotericin B…
