When should surgery be offered for uncomplicated acute diverticulitis? What is laparoscopic peritoneal lavage? The classic surgical tenet that patients with two or more attacks should undergo colectomy has been challenged, as has the concept that patients at the ends of the age spectrum should have more aggressive surgical intervention. Newer data suggests that it …
What is the best method to diagnose pain secondary to mesenteric ischemia? Despite multiple modalities (CT, US, angiography) to assess intestinal vascular flow, high index of suspicion, a careful history, and physical examination remain the best method to diagnose mesenteric ischemia. Pain out of proportion to physical examination is a classic finding. Atrial fibrillation, recent …
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Surgical strategy for the treatment of Crohn’s disease Because of the chronicity of the disease, any surgical strategy should be to maximize small bowel length. Strictureplasty has been shown to be an effective measure with multiple Crohn’s strictures and maintains small bowel length. In the setting of long segments of disease, resection is generally limited …
What are omental infarction and epiploic appendagitis and how are they related? What is the ideal treatment of these processes? Spontaneous torsion or infarction of either the omentum or epiploic appendages of the colon can mimic either appendicitis or other acute abdominal pathologic conditions based on their location. For both, the process is generally self-limiting, …
When is surgery indicated for severe acute pancreatitis? Patients with progressively hemorrhagic or necrotizing infected pancreatitis should undergo surgery when resuscitative measures fail. Both CT-guided catheter drainage of well-localized pancreatic abscesses as well as endoscopic decompression of well-formed pseudocysts may be an alternative. Despite aggressive surgery, mortality rates are still in excess of 40% in …
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When is cholecystectomy optimal for acute pancreatitis, presumably caused by gallstone disease? Classically, patients with gallstone pancreatitis would undergo cholecystectomy 4 to 6 weeks following their initial hospitalization; however, more recent studies show high recurrence rates with this delay. In addition, early surgery (i.e., during the same hospitalization, after pain has resolved) has shown similar …
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When is surgery indicated for PUD? • Perforation: Closure with an omental or a Graham patch is acceptable for patients without previous history of PUD and for hemodynamically unstable patients. Definitive antiulcer surgery is indicated in hemodynamically stable patients with a prior history or chronic PUD. Resection of the ulcer crater with adequate margins should be …