Emergency surgical care

The concept of "acute abdomen" in surgery

The term "acute abdomen" is a collective one. It brings together pathological processes of diverse etiology and clinical course that occur acutely in the abdominal cavity. It is important to understand that in the classical sense, this is not a final independent diagnosis. It is a specific clinical symptom complex, the main task of which is exclusion of acute surgical pathology of the pelvic and abdominal organs. Such life-threatening conditions include peritonitis, internal bleeding, acute intestinal obstruction, and any destructive process.

Absolutely all conditions falling under this definition dictate the need for immediate hospitalization of the patient. A physician of any specialty encountering such a clinical picture is obliged to urgently refer the patient for a surgical consultation. It is strictly prohibited to waste time attempting to establish a precise nosological diagnosis at the pre-hospital stage, as this delays the delivery of specialized care.

Emergency consultation regulations

When admitting a patient with suspected urgent pathology, every minute counts. Standards define strict timeframes and indications for involving multidisciplinary specialists (all recommendations have a reliability level of C, evidence level of 5):

• Surgeon: Examines the patient strictly within the first 30 minutes from admission. Indications include intense abdominal pain, hemorrhagic syndrome, or hypotension. The main goal is to exclude acute surgical pathology and decide on transfer to the surgical department.
• Anesthesiologist-Resuscitator: Consultation is also performed no later than 30 minutes from hospitalization. The specialist is called in the presence of any emergency conditions (including hepatic coma) to determine indications for the immediate transfer of the patient to the intensive care unit (ICU).
• Neurologist: Involved in the diagnostic search when the patient shows signs of encephalopathy to provide timely specialized neurological care.

Instrumental diagnostics

As part of emergency care, specific diagnostic methods aimed at differential diagnosis are used (recommendation level C, evidence level 5):

1. Electrocardiography (ECG): Mandated for all patients with typhoid fever. The study is necessary to identify pathological changes in the heart that develop against the background of hypoxia, marked microcirculatory disorders, and dystrophic processes.
2. Videocolonoscopy: Indicated for patients in whom abdominal pain is combined with signs of lower gastrointestinal bleeding. The method allows for accurate differential diagnosis and timely specialized care.

Management of myomatous node degeneration and necrosis

One of the causes of the "acute abdomen" clinical picture in gynecology is uterine fibroid pathology. In case of node degeneration, conservative therapy is performed at the first stage. Emergency care begins with infusion therapy, the goals of which are relief of intoxication and normalization of water-electrolyte balance. Additionally, pharmacotherapy is prescribed: antispasmodics, anti-inflammatory drugs, and microcirculation-improving agents. The effectiveness of conservative measures is evaluated within the next 24–48 hours.

If the patient develops node necrosis (without signs of peritonitis), surgical intervention is indicated. Priority is always given to organ-sparing surgeries. For women of reproductive age, conservative myomectomy is the method of choice. In premenopausal and postmenopausal patients, the scope is expanded: either subtotal hysterectomy or total hysterectomy is indicated.

Indications for emergency surgery:

• Progressive deterioration of the patient's condition.
• Lack of effect from ongoing conservative therapy within 1–2 days.
• Onset of clinical signs of peritonitis.

Note: The final scope of surgical intervention is determined by the surgeon strictly individually, based on the intraoperative picture.

Class and exam questions

What else to study on this topic

• Ectopic pregnancy: variants and localization of the gestational sac.
• Clinical manifestations and diagnostic methods for tubal abortion.
• Symptoms and surgical tactics for fallopian tube rupture.
• Torsion of the pedicle of ovarian masses: clinical presentation and diagnostics.
• Differential diagnosis of gynecological causes of "acute abdomen".

Other topics in the "Additional Topics" section

Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.