Match each clinical presentation of an acute surgical abdomen to the most appropriate next step in management.
- A 35-year-old man presents with 5 days of right lower quadrant pain, fever, and leukocytosis. Computed tomography (CT) reveals a 6.5-cm periappendiceal abscess without generalized peritonitis.CT-guided percutaneous drainage and intravenous antibiotics
- A 71-year-old woman is admitted with sudden-onset, severe generalized abdominal pain, confusion, and a systolic blood pressure of 85 mm Hg. CT imaging demonstrates sigmoid diverticulitis with diffuse pneumoperitoneum.Emergent exploratory laparotomy, bowel resection, and end colostomy
- A 52-year-old man presents with left lower quadrant pain and low-grade fever. CT reveals sigmoid diverticulitis complicated by a localized 1.5-cm pericolic fluid collection.Intravenous antibiotics and bowel rest alone
- A 58-year-old man with a history of open appendectomy presents with obstipation, abdominal distension, and bilious vomiting. CT reveals a small bowel transition point with normal wall enhancement.Nasogastric tube decompression and intravenous fluid resuscitation
Cevap
The 6.5-cm abscess matches with percutaneous drainage; the perforated diverticulitis with shock matches with emergent laparotomy; the 1.5-cm microabscess matches with IV antibiotics alone; and the uncomplicated small bowel obstruction matches with nasogastric tube decompression.
Appropriate triage relies on established surgical indications. Uncomplicated small bowel obstruction and small (<3 cm) abscesses are managed conservatively. Large abscesses (>4 cm) require percutaneous drainage to allow inflammation to subside prior to any definitive operation. Free perforation with hemodynamic instability requires emergent operative source control.
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Anahtar Kavram
Surgical triage of the acute abdomen based on complication severity, imaging findings, and hemodynamic stability