GRH Abdominal Surgery

There are a number of conditions that can cause acute or intermittent vomiting, including gastrointestinal foreign bodies, pancreatitis and gastroenteritis. With foreign bodies, palpation may be diagnostic though in most cases, imaging confirmation of gastrointestinal foreign bodies is paramount, using radiographs, ultrasound or CT. On radiographs, signs consistent with obstruction include masses (soft tissue or radio-opaque, distended loops of small intestine (diameter > twice the height of L5) and plication. Ultrasound can be very useful in the hands of a skilled operator, often giving location of obstruction and any evidence of peritoneal effusion with high sensitivity and specificity. Surgical considerations include enterotomy versus enterectomy, suture techniques, needle type, stapling versus sutures and use of drains to aid post-operative surveillance. Post-operative management is crucial, with early enteral feeding important and careful monitoring and management of pain and ileus. Post-operative analgesia will be examined, including the evidence base for the use (or with-holding) of non-steroidal anti-inflammatories. Known risk factors for increased complications are covered and methods of decreasing complications such as the surgical check list discussed.