Study and management of non traumatic abdominal surgical emergencies

INTRODUCTION: An imprecise term ‘ACUTE ABDOMEN’ leaves much to be desired from a semantic point of view but is useful in practice; included under the heading are all of the painful abdominal syndromes, sometimes benign; frequently potentially lethal and of several origins; characterized by sudden appearance of pain with accompanying local and general signs and symptoms. “The majority of abdominal pains which ensue patients who have been previously fairly well and which lasts as long as 6 hours are caused by conditions of surgical importance”. The term “Acute Abdomen” denotes a morbid condition with the sudden onset of abdominal pain requiring prompt decision making and surgical intervention correct interpr. After making the diagnosis based on accurate history and the correlation of physical findings, surgical intervention must be planned with the aid of roentgenograms of the abdomen, a blood count and urine analysis and other laboratory investigations. AIM OF THE STUDY: 1. To analyse the incidence of Non traumatic abdominal surgical emergencies treated in Govt. Rajaji Hospital, Madurai, in relation to Sex, age etc. 2. To compare the reliability of clinical signs versus radiological signs and preoperative findings versus peroperative findings and post operative outcome. 3. To find out the relative incidence of various abdominal surgical emergencies. (Children below the age of 12 years and gynaecological emergencies are not taken up for this study) METHODS AND MATERIALS: This study material consists of 365 cases of Acute abdomen admitted in seven surgical units in our Department of Surgery, Madurai Medical College, Govt. Rajaji Hospital during the period from Oct 2008 to Sep 2009. All these cases of pain abdomen admitted in surgical ward were carefully and thoroughly examined to arrive at a clinical diagnosis. A preformed proforma was carefully filled up giving particulars. Importance to the duration of illness and general and special investigation wherever possible. The following procedure were adopted according to the conditions of the patient ie. conservative management and emergency surgeries. Based on clinical diagnosis, Investigation patients opted for emergency surgery. In selected cases, pre operative, peroperative and post operative clinical and operative photographs were taken. All the patient were followed up in the immediate post operative period and in the subsequent period for 3 months till the end of study. CONCLUSION: Judging from the results of this present study it comes to a firm conclusion that the 1. Acute abdominal emergency incidence is more common in males when compared to that of females. 2. Among the Duodenal perforation NSAIDs induced were more common. 3. Smaller perforation < 1 cm can be closed with Graham’s live omental patch closure. 4. In larger perforation, serosal patch closure can be done for better results. 5. Smaller the perforation and shorter the duration better the outcome with low morbidity and mortality. 6. Among the ileal perforation most common etiology found to be enteric fever. Prognosis is good if resection anastomosis done in larger perforation and in unhealthy bowel. 7. Incase of intestinal obstruction major cause were due to post operative adhesions. Next is groin hernias. Mortality increases with prolonged surgery, age > 50 years and in extensive bowel resection. Decreased urine output, tachycardia, and fever in the immediate post operative period indicates anastomotic dehiscence. 8. Incase of liver abscess laparotomy and drainage in multiple and large abscess should be done for better results. 9. Early cholecystectomy is treatment of choice in patient with acute cholecystitis with acceptable risks. 10. In unequivocal clinical diagnosis in case of appendicitis should be subjected to USG abdomen reduces the rate of negative appendicectomy