Transcript Abdominal Catastrophe

ABDOMINAL CATASTROPHE
Don R. Fishman, MD
Trauma Medical Director
Overland Park Regional Medical Center
ABDOMINAL CATASTROPHE
A momentus tragic event ranging from
extreme misfortune to utter overthrow or
ruin.
Peritonitis from a visceral source.
ABDOMINAL CATASTROPHE
Mesenteric Ischemia
Toxic Megacolon
Necrotizing pancreatitis
Perforated Viscus
ABDOMINAL CATASTROPHE
Mesenteric ischemia: a condition in which the
supply of oxygen is too small to satisfy the
needs of the intestines.
Occlusive
Non-occlusive
ABDOMINAL CATASTROPHE
Occlusive causes:
strangulation
arterial emboli
arterial thrombosis
venous thrombosis
complications of aortoiliac disease and/or
surgery
trauma
ABDOMINAL CATASTROPHE
Non occlusive causes:
cardiogenic shock
peripheral artery disease
septic shock
cardiac arrhythmias
vasoconstrictive medications
cocaine abuse
NECROTIZING PANCREATITIS
Failure to opacify the pancreas
10% incidence
Scoring systems
Ranson
Apache
Balthazar (CTSI)
NECROTIZING PANCREATITIS
Operative vs. Non-operative
Non-operative treatment
no infection
equivalent - improved mortality
+/- antibiotics
mortality 0-6%
NECROTIZING PANCREATITIS
Operative
infected
complications
bleeding
obstruction
open vs. laparoscopic
mortality 15-30%
TOXIC MEGACOLON
Severe inflammatory conditions
inflammatory bowel
ischemic colitis
infectious colitis
C. diff
TOXIC MEGACOLON
Presentation
abdominal distension
tachycardia
fever
leukocytosis
anemia
oliguria
peritoneal signs
TOXIC MEGACOLON
Diagnosis
CT (94%)
fat stranding
wall thickening
ascites
absence or distortion of haustral folds
“target sign”
TOXIC MEGACOLON
Treatment
medical
endoscopic
operative
TOXIC MEGACOLON
Endoscopy
suspicion but negative assay
diagnosis needed before assay result
failure of response to medical therapy
atypical presentation
TOXIC MEGACOLON
Operative intervention
perforation
progressive dilatation of colon
lack of clinical improvement
uncontrolled bleeding
Procedure: total abdominal colectomy
Neal, MD, et al. Ann Surg 2011; 254; 423-429
TOXIC MEGACOLON
Mortality
Overall 30-80%
Surgery 30-60%
5 year 62%