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Abdominal Catastrophe

Abdominal Catastrophe

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Abdominal Catastrophe

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  1. Abdominal Catastrophe Don R. Fishman, MD Trauma Medical Director Overland Park Regional Medical Center

  2. ABDOMINAL CATASTROPHE A momentus tragic event ranging from extreme misfortune to utter overthrow or ruin. Peritonitis from a visceral source.

  3. ABDOMINAL CATASTROPHE Mesenteric Ischemia Toxic Megacolon Necrotizing pancreatitis Perforated Viscus

  4. 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

  5. ABDOMINAL CATASTROPHE Occlusive causes: strangulation arterial emboli arterial thrombosis venous thrombosis complications of aortoiliac disease and/or surgery trauma

  6. ABDOMINAL CATASTROPHE Non occlusive causes: cardiogenic shock peripheral artery disease septic shock cardiac arrhythmias vasoconstrictive medications cocaine abuse

  7. NECROTIZING PANCREATITIS Failure to opacify the pancreas 10% incidence Scoring systems Ranson Apache Balthazar (CTSI)

  8. NECROTIZING PANCREATITIS Operative vs. Non-operative Non-operative treatment no infection equivalent - improved mortality +/- antibiotics mortality 0-6%

  9. NECROTIZING PANCREATITIS Operative infected complications bleeding obstruction open vs. laparoscopic mortality 15-30%

  10. TOXIC MEGACOLON Severe inflammatory conditions inflammatory bowel ischemic colitis infectious colitis C. diff

  11. TOXIC MEGACOLON Presentation abdominal distension tachycardia fever leukocytosis anemia oliguria peritoneal signs

  12. TOXIC MEGACOLON Diagnosis CT (94%) fat stranding wall thickening ascites absence or distortion of haustral folds “target sign”

  13. TOXIC MEGACOLON Treatment medical endoscopic operative

  14. TOXIC MEGACOLON Endoscopy suspicion but negative assay diagnosis needed before assay result failure of response to medical therapy atypical presentation

  15. 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

  16. TOXIC MEGACOLON Mortality Overall 30-80% Surgery 30-60% 5 year 62%