Core Topics in General & Emergency Surgery: Companion to Specialist Surgical Practice by Paterson-Brown MBBS MPhil MS FRCS Simon

Author:Paterson-Brown MBBS MPhil MS FRCS, Simon [Paterson-Brown MBBS MPhil MS FRCS, Simon]
Language: eng
Format: epub
ISBN: 9780702049729
Publisher: Elsevier Health Sciences UK
Published: 2013-06-24T00:00:00+00:00

10

Colonic emergencies

David E. Beck

Introduction

Emergency conditions of the large bowel are common and changes in their evaluation and management have continued. Rather than rushing the patient to the operating room after a token resuscitation, current standards suggest that an initial appropriate period of resuscitation along with physiological and radiological evaluation should be undertaken. Many patients with colonic conditions can be managed non-operatively with bowel rest, antibiotics and blood components. Comorbid disease such as cardiac, pulmonary and metabolic conditions are optimised and critically ill patients are monitored in an intensive care setting. If adequate facilities and personnel are not readily available, transfer to a tertiary care facility should be considered if the patient can be readily stabilised.

The operative mortality for emergency colon resections is two to three times that associated with elective resection. As a result, surgeons have investigated ways of stabilising patients in order to convert emergency into more planned, elective procedures. Deciding if and when to operate can be difficult, and active observation and consultation with colleagues is often helpful in the decision-making process. Active participation of the attending/consultant surgeon in both the assessment and operative procedure is essential in this group of very challenging patients.

When emergency surgery is necessary, there has been a clear trend towards single rather than staged procedures for large-bowel disorders. When feasible, this approach reduces the length of hospital stay and avoids the risks of multiple operations. However, in some unfit or acutely septic patients, a staged approach may still be preferable.

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