Urgent surgical care. Emergency abdominal surgery - Zatevakhin I.I.

At the EMC Surgical Clinic, patients with emergency surgical conditions are provided 24 hours a day.

What we treat:

acute cholecystitis (biliary colic), obstructive jaundice;

perforated ulcer of the stomach and duodenum;

acute intestinal obstruction, intussusception;

acute pancreatitis, pancreatic necrosis;

peritonitis;

acute paraproctitis;

gastrointestinal bleeding, bleeding from the rectum;

injuries to the abdominal and thoracic organs;

abscess, phlegmon, boil, carbuncle, panaritium, infected wounds.

A qualified surgical team specializing in providing emergency and urgent surgical care is on duty at the EMC around the clock. EMC diagnostic services also operate around the clock. This allows you to conduct both laboratory and instrumental diagnostics, including performing, if necessary, any types of ultrasound, x-ray, endoscopic studies, as well as computed tomography and magnetic resonance imaging. Availability of diagnostic departments equipped with last word equipment and working around the clock, allows you to supply accurate diagnosis, determine the amount of surgical intervention required and prepare for surgery as soon as possible.

All emergency service surgeons have many years of experience and are proficient in the full range of techniques for performing urgent and emergency operations, including minimally invasive and laparoscopic, which makes surgical treatment less traumatic and minimizes pain syndrome after surgery, reduce blood loss and the likelihood of developing postoperative complications, shorten the patient’s recovery period and length of hospital stay.

IN postoperative period The medical staff of the clinic ensures a high level of medical care and service, professional care, care and attention to each patient both during their hospital stay and during subsequent outpatient follow-up.

If you need emergency surgical care, You can always contact EMC clinics directly, call our multi-line phone or use the 24-hour emergency medical service. If necessary, hospitalization and emergency surgery an ambulance team will take you to Surgical clinic EMC. The emergency doctor transfers the patient to the emergency department doctor and emergency assistance, and then to the surgeon, thereby ensuring continuity medical supervision and maximum safety at all stages of support and treatment.

Emergency surgical care may be required for conditions that threaten the patient's life. Conventionally, such conditions can be divided into two groups:

arising under the influence external factors or injuries: blunt force trauma to the abdomen with rupture internal organs, Availability foreign bodies in organism;

arising under the influence internal factors and complications of diseases: abscesses, phlegmon, appendicitis, peritonitis, etc.

How is emergency surgery performed?

Upon admission of a patient to the emergency surgery department of the Best Clinic, immediate preparation for surgery begins. The patient is immediately given necessary tests, x-ray or ultrasound to reduce the risks of surgery.

Whenever possible, our specialists try to perform not abdominal, but laparoscopic surgery - mini-punctures in the place where surgical intervention is necessary. All operations are performed using advanced European and American equipment - for safe surgical interventions with minimal trauma.

Only high-quality drugs are used for anesthesia. The injection is given in the ward so that the patient is not bothered by the natural fear of the operation. And in the operating room there are monitors to measure the depth of anesthesia.

Rehabilitation

After the operation, the patient is observed in the hospital. The length of stay under observation depends on the complexity of the operation and the patient's condition.

At the Best Clinic inpatient facility, you will be under the 24-hour supervision of specialists and medical personnel. Each bed has a staff call button in case you need anything.

Upon discharge, the Best Clinic doctor will give detailed recommendations on the limitations of the recovery period.

The most important thing is to determine that a person needs emergency surgical care. Even if no damage is visible, but the person turns pale, feels worse and loses consciousness, it is necessary to urgently contact medical institution.

The patient should not be given food or water until examined by a doctor.

Genre: Surgery

Format: PDF

Quality:OCR

Description: The guide reflects the issues of organizing emergency surgical care for diseases and organ injuries abdominal cavity, the principles of their diagnosis, methods of surgical and conservative treatment are outlined. The main tasks that a surgeon must solve in case of a particular pathology of the abdominal organs are formulated, modern treatment and diagnostic algorithms are given, and key points are highlighted that a doctor providing assistance to this most difficult group of patients and victims must take into account.
For doctors undergoing retraining in abdominal surgery, surgical residents and 4-6 year students medical universities specializing in surgery.

The present and future of emergency abdominal surgery

Urgent abdominal surgery unites wide range diseases and injuries of the abdominal cavity and retroperitoneal space with a high risk of mortality. Despite the different etiologies, acute surgical diseases and visceral trauma include bleeding, surgical infection, organ ischemia, intra-abdominal hypertension and organ dysfunction.

Prognosis for these pathological conditions significantly worsens when deviating from the developed algorithms for their diagnosis and treatment, as well as when there is inadequate organization of medical and, in particular, surgical care. Good results in the treatment of emergency surgical diseases indicate high level development of healthcare in the state and its regions, since morbidity and mortality from this pathology currently remain extremely high. For example, of the 51 million people who died worldwide in 2012, 17 million suffered from diseases that could be treated surgically.

The main trend of modern surgery is to reduce invasiveness surgical interventions . Application of a step-by-step approach consisting in differentiated tactics of using conservative therapeutic measures, minimally invasive interventions and, finally, laparotomy, allows for an individualized approach to surgical patients, avoid unnecessary, extremely traumatic and sometimes crippling operations. An important role is given to minimally invasive methods of intervention: laparoscopic, intraluminal endoscopic, X-ray endovascular, percutaneous (under X-ray, ultrasound or CT navigation).

Of course, the most severe category of emergency patients are patients with peritonitis, septic shock, intra-abdominal hypertension syndrome, severe blood loss. Treatment of these dangerous conditions requires impeccable mastery of general surgical manipulations, blood-saving technologies, methods of staged management of an open abdomen, decompression of the abdominal cavity and methods of its closure. At the same time, the proportion of such severe patients in the structure of emergency surgical pathology is relatively small. In this regard, it is extremely important to use technologies aimed at reducing the aggression of surgical intervention. Modernization of surgical equipment and consistent training of surgeons in endovideo surgery skills over the past decade have led to a significant increase in the number of laparoscopic interventions.

Laparoscopic operations have become the method of choice in the treatment of acute appendicitis, acute cholecystitis and perforated ulcers. We can say that they have become part of routine surgical practice.

During this time, the methods of typical operations using endovideoscopic technology have been standardized, precise criteria for conversion have been adopted, and methods for such interventions have been developed for complicated forms of diseases. Surgeons have reached a “learning plateau.” One of the important achievements of the introduction of laparoscopy in the surgery of acute appendicitis was the reduction in the number of wasted appendectomies from 25-30% to 1-2%, since the detection of unchanged vermiform appendix with an open approach, in most cases, it prompted the surgeon to perform an appendectomy in order to justify his actions.

Currently, experience is being accumulated and the possibilities of laparoscopic operations in the treatment of acute intestinal obstruction are being studied, strangulated hernia, widespread peritonitis, abdominal trauma. The training period for this pathology is much longer, which is associated with more complex technical techniques. In addition, due to the lack of proven advantages of the laparoscopic approach, many surgeons are ambivalent about it.

Intraluminal diagnostic and therapeutic techniques nowadays they play a big role in the diagnosis and treatment of emergency diseases. Endoscopic hemostasis has become the leading method of stopping bleeding in the gastrointestinal tract. Surgical interventions under endosonography control are now available: sanitation of cavities and removal of sequesters for pancreatic necrosis through back wall stomach, a wide range of transpapillary interventions for obstruction of the biliary tree, creation of anastomosis between gallbladder And duodenum in case of acute cholecystitis if it is impossible to perform radical surgery. A relatively new method is the use of self-expanding stents to relieve obstructions. various departments gastrointestinal tract, and when using covered stents (stent grafts) - also for sealing the lumen of hollow organs.

Percutaneous interventions under radiation control in the treatment of many urgent diseases play no less than important role than laparoscopy. Thus, the use of percutaneous puncture and drainage has become the leading method of treating fluid accumulations in pancreatic necrosis, appendiceal abscesses, postoperative complications, injury. Puncture and drainage of the gallbladder are the leading methods of treating acute cholecystitis in patients with severe concomitant pathology and preparing them for radical surgery.

Endovascular interventions allow hemostasis due to selective embolization of areas of extravasation from the vessels supplying blood to the pathological focus in ulcers, tumors and trauma, changing the usual treatment algorithms, allowing one to abandon laparotomy. Along with ultrasound, X-ray methods became navigation for accessing the biliary tree for its unloading in hypertension.

The improvement of minimally invasive approaches and methods of conservative treatment creates algorithms in which the concept of a “non-operative” approach to the treatment of many emergency surgical diseases is increasingly important: ulcerative bleeding, trauma to parenchymal organs, pancreatic necrosis, intestinal obstruction, and a number of postoperative complications.

Currently, issues of replacing operations with conservative therapy, for example in acute appendicitis, are being considered. However, convincing data indicating the unconditional effectiveness conservative therapy, not received yet. Conservative treatment appendicitis may be considered in extreme cases high risk surgery, pregnancy, categorical refusal of the patient. It is necessary to understand that the increase in the number of cases of non-operative treatment of surgical diseases requires close supervision of the surgeon and was made possible thanks to the round-the-clock availability of highly effective diagnostic methods- Ultrasound, endoscopy, computer and magnetic resonance imaging. Obviously, a patient with non-operative treatment of a surgical disease should be in a surgical hospital, since surgical treatment may be needed at any time, the line of indications between surgical and non-operative treatment is often blurred, which often leads to delays in operations and is fraught with a potential increase in diagnostic tests. errors.

Application of accelerated rehabilitation protocols in emergency surgery to date, little has been studied, but the interest of surgeons in this problem is growing. It is known that many options of a multimodal approach to accelerated rehabilitation are quite applicable to urgent surgery. Moreover, the introduction of laparoscopic operations into emergency surgery makes it possible to classify a number of patients into the category of those who can be treated in short-stay hospitals.

Prospects for the development of emergency abdominal surgery consist in developing the knowledge and skills of a surgeon focused on providing care to the most severe category of patients. Compliance with algorithms based on evidence-based recommendations is an important, but not the only factor in improving the results of treatment of urgent surgical diseases. The basis for the quality work of an “emergency surgeon” should be laid at the stages proper training And modern organization emergency surgical care.

Preparation general surgeon assumes a clear orientation in endoscopy and interventional radiology, mastery of traditional and laparoscopic skills in hemostasis and intestinal suturing. He must be trained in basic surgical techniques, the use of staplers, and methods of staged management of an open abdomen.

This requires the creation curricula, combining the acquisition of theoretical knowledge with the opportunity to develop practical skills in conditions close to real ones. This is possible thanks to the introduction of cadaver courses and work in operating rooms with laboratory animals on living tissues.

Organization of surgical care for the sick and injured should be to reduce the time of delivery of patients to the hospital, minimize their stay in emergency departments, rapid triage and subsequent correct decision-making on diagnosis and treatment. The creation of specialized centers providing care to patients with trauma and emergency diseases shows their high efficiency. Meanwhile, today in Russia, due to complex geographical and climatic conditions It is not always possible to transport the patient to a specialized hospital. That is why it is extremely important to adhere to the stages of surgical care, based on the elimination of life-threatening conditions and the subsequent transfer of the patient to a specialized stage (damage contlrol tactics).

We hope that the Guide offered to readers will serve as a kind of ABC for novice surgeons, and will allow experienced surgeons to abandon a number of familiar but obsolete dogmas, to a certain extent changing their views on emergency surgery.

"Emergency abdominal surgery"

ORGANIZATIONAL ISSUES

• Organization of emergency surgical care
• Features of the organization of assistance for abdominal injuries during terrorist attacks and military operations
• Accelerated rehabilitation in emergency abdominal surgery

BLEEDING

• Bleeding from the upper gastrointestinal tract
• Bleeding from the small and large intestine
• Intra-abdominal bleeding
• Rupture of an aneurysm of the abdominal aorta and its visceral branches
• Modern principles of blood loss replacement

ABDOMINAL SURGICAL SEPSIS

• Acute appendicitis
• Perforated ulcer of the stomach and duodenum
• Strangulated hernia
• Diffuse purulent peritonitis
• Principles of treatment of abdominal surgical sepsis

ACUTE INTESTINAL DISEASES

• Non-neoplastic mechanical intestinal obstruction
• Tumor obstruction of the colon
• Acute disorders of mesenteric circulation
• Complicated diverticular disease of the colon
• Non-tumor intestinal diseases in surgical practice

DISEASES OF ORGANS OF THE HEPATOPANCREATOBILIARY ZONE

• Acute cholecystitis
• Obstructive jaundice
• Cholangitis and liver abscesses
• Acute pancreatitis

ABDOMINAL TRAUMA

• Damage to hollow organs
• Rectal injuries
• Damage to parenchymal organs
• Pelvic hematomas: causes, consequences, surgical tactics
• Features of gunshot and mine-explosive abdominal trauma

POSTOPERATIVE COMPLICATIONS

• General issues of prevention of postoperative complications
• Treatment of surgical site infections
• Modern tactics of treatment of postoperative purulent intra-abdominal complications
• Principles of treatment of non-infectious intra-abdominal complications

SURGICAL PROBLEMS OF RELATED SPECIALTIES

• Acute gynecological diseases in the practice of a surgeon
• Acute abdomen in pregnant and postpartum women
• Acute abdomen in childhood
• Acute urological pathology in emergency surgical practice

There are a number of diseases that require urgent surgical treatment. Ignoring its necessity threatens with serious consequences for the patient, including death. Emergency surgical intervention is intended to prevent such situations.

Indications for emergency surgery

Health problems that require emergency surgical intervention may arise against the background chronic illness or completely suddenly. In any case, the need for surgery is indicated by characteristic clinical symptoms. It can be:

• expressed painful sensations;
• bleeding;
• loss of consciousness;
• convulsions.

Any of these symptoms is a good reason to urgently contact a medical facility. The sooner an accurate diagnosis is made by a doctor, the higher the patient’s chances of recovery. Self-medication in such situations is unacceptable, since it threatens with critical consequences for the body.

Types of emergency surgical operations

Urgent operations are most often performed when the following diagnoses: acute appendicitis and pancreatitis, perforated gastric ulcer, renal colic, ovarian rupture, etc. On the clinic’s website https://centr-hirurgii-spb.ru/ you can find the entire list of diseases that require the emergency participation of surgeons. But you should always remember that in difficult cases To make decisions about performing an operation, specialists have an extremely limited time interval. Therefore, you should contact the clinic immediately after the obvious manifestation of a disturbing symptom.

At severe pain, bleeding or other dangerous symptoms, it is best to receive help in medical institutions that have their own laboratory. Its presence allows the doctor to carry out comprehensive examination patient, promptly make a reliable diagnosis and provide emergency surgical care.

The rehabilitation process after emergency and elective surgery goes identically. After surgery, the patient is transferred to a ward in the inpatient department. There, under 24-hour medical supervision, he remains until discharge. The specifics of further recovery at home are determined by the type of disease, the volume of surgical intervention and physical condition the patient as a whole.

Emergency surgical care is resorted to when a life-threatening condition occurs, and time is literally counted by hours, and sometimes even minutes. It is easy to imagine that the responsibility lies with the surgeons providing emergency assistance, lies colossal, and therefore the most competent and at the same time the most skillful specialists work in this specialty. But a person’s salvation depends not only on how qualified the doctor is. It is important that emergency surgical care is provided in a timely manner - as soon as possible after a threat to life has been established.

Life-threatening conditions

Conditions that require emergency surgical care can be divided into two large groups:

• Arising under the influence of exogenous factors, or trauma;
• Arising under the influence endogenous factors, or acute complications existing diseases.

Injuries that pose an immediate threat to life include not only those terrible wounds when large blood loss and traumatic shock are obvious. Often trauma with a blunt object, without breaking the integrity skin no less dangerous, and are also subject to surgical treatment. Examples include blunt trauma to the abdomen, which causes rupture of the spleen or other organs, resulting in massive internal bleeding, or brain contusions, in which the destruction of brain tissue can be quite severe, although the first symptoms may not be noticeable.

In pediatric practice, another type of condition often occurs when emergency surgical intervention is likely to be required, this is the presence of a foreign object in the body. Young children, when playing with small objects, often stick them into their nose, ear, swallow or inhale them. This situation requires immediate medical intervention, and if the item cannot be removed conservative ways, resort to emergency surgery.

Acute complications chronic diseases that require emergency surgical care are an abscess or empyema (suppuration of an inflamed organ or tissue with the threat of its rupture and spillage of pus into the surrounding space), phlegmon (acute purulent inflammation fiber), appendicitis, peritonitis, intestinal obstruction, internal bleeding, perforation or perforation of any organ.

How to determine if emergency surgery is required?

Emergency surgical care for injuries is necessary when there is externally visible serious damage to organs or tissues, and not necessarily with bleeding (burns and frostbite, for example). If there are no visible dangerous injuries after the injury, but the person feels worse and worse, turns pale, the pain intensifies, or he loses consciousness, this is a direct indication that he most likely needs emergency surgical care. In this case, it is unacceptable to self-medicate; you must immediately call ambulance. It is especially undesirable to give any medications, in particular analgesics. Medicines in this condition are unable to solve the problem, but they can completely confuse the symptoms or even cause a deterioration in the patient’s condition. All medications without exception, a doctor must prescribe it after the initial examination. In such a condition, the patient should also not be allowed to eat or drink until a medical examination has been performed.

Regarding complications inflammatory diseases, then there are also some signs that emergency surgery is required, and it is very important not to miss them, especially when the patient is at home and not in hospital treatment.

How to determine that the disease has entered a dangerous phase? Firstly, this is a long-term painful attack. It is believed that if a painful attack during bile or renal colic lasts more than six hours and cannot be relieved with analgesics, then this should alert you to the appearance of one of the serious complications - either perforation of the organ, or its suppuration with rupture. In such situation home treatment it is extremely dangerous to continue, immediate assistance is required inpatient conditions, since there is a very high probability that emergency surgery will be required.

Increasing pallor, worsening condition, sharp pain in the abdomen combined with tension abdominal wall(syndrome acute abdomen), confused consciousness or loss of consciousness, weak voice, forced body position - all these are symptoms of a probable surgical pathology.

The first thing doctors focus on when detecting a condition is life-threatening, this is a fight against shock. To this end, in urgently antishock therapy is carried out: solutions of electrolytes are administered intravenously, designed to replenish the fluid balance of the body, and drugs whose action is aimed at maintaining cardiac activity. When the condition is more or less stabilized, surgery begins.

If we are talking about open injury, the stages of emergency surgical care are as follows: pain relief, revision (examination) of the wound, removal of tissue scraps and bone fragments, layer-by-layer suturing of tissue, establishment of drainage.

Emergency surgical care for closed wounds, as well as complications internal diseases, is complicated by the fact that it is not always clear what exactly happened. Therefore, emergency diagnosis is necessary. If we are talking about a traumatic brain injury with suspected brain contusion, computed tomography. In the case of diseases of the abdominal organs, the approach is diagnostic surgical intervention as a rule, this is diagnostic laparoscopy. This allows you to save time and immediately begin providing assistance when a pathology is detected. Sometimes this happens by means of laparoscopy, which goes from diagnostic to therapeutic; in some cases, laparoscopic intervention is transferred to abdominal surgery. The essence of the actions is similar to those during surgery for injury: revision, washing the operating area with an aseptic solution to remove pus, blood or other foreign substances (for example, intestinal contents during intestinal perforation), restoring the integrity of organs with subsequent suturing of tissues, if performed abdominal surgery. With laparoscopic surgery, no incision is made, so this step is omitted. Then the wound is drained.

At this point, emergency surgical care is completed, the patient is transferred to the surgical intensive care unit, where he remains until his condition stabilizes.