Ileostomy creation and care was revolutionized with the description of the eversion technique by Brooke in 1952. Eversion eliminates the serositis reaction commonly observed from the proteolytic ileal effluent. Another advance has occurred with the widespread employment of trained nurse enterostomal therapists to educate and care for patients with ostomies. […]
Appendectomy is the most common urgently performed surgical procedure.
Lifetime risk of undergoing appendectomy is between 7% and 12%.
The maximal incidence occurs in the second and third decades of life.
Evaluation of the patient with acute abdominal pain requires a careful history and physical examination by a skilled physician in conjunction with selective diagnostic testing. Acute abdominal pain is the most common general surgical problem presenting to the emergency department.
Neoplasms of the small bowel occur infrequently and account for fewer than 2% of all GI neoplasms. Tumors of the small intestine present insidiously with vague, nonspecific symptoms. Most benign tumors are diagnosed incidentally; however, they can act as lead points in an intussusception.
Crohn Disease is an idiopathic, chronic, granulomatous inflammatory disease that can affect any part of the GI tract from the mouth to the anus. It is an incurable,slowly progressive disease characterized by episodes of exacerbation and remission. The incidence is 4/100,000, with a bimodal age distribution among those 15 to 29 and 55 to 70 years old.
In the adult, the length of the small bowel varies from 300 to 600 cm and correlates directly with body surface area. Several factors determine the severity of short-bowel syndrome, including the extent of resection, the portion of the GI tract removed, the type of disease necessitating the resection, the […]
A. General Upper and lower gastrointestinal bleeding are discussed in Chapters 9 and 12, respectively. Small-bowel lesions are the most common cause of “obscure gastrointestinal bleeding,” defined as hemorrhage that persists or recurs after negative initial upper and lower endoscopies. B. Diagnosis Enteroscopy Push enteroscopy employs a 400-cm enteroscope to […]
Adhesions are the most common cause of small-bowel obstruction in U.S. adults. Most adhesions result from previous abdominal operations or inflammatory processes, although isolated congenital adhesions can occur as well.
Incarcerated hernias are the second-most-common cause of small-bowel obstructions in industrialized nations. They are the most common cause of SBO worldwide. In industrialized nations, they are the most common cause of SBO in children and in patients without prior abdominal surgery.
Intussusception occurs when one portion of bowel (the intussusceptum) telescopes into another (the intussuscipiens). Tumors, polyps, enlarged mesenteric lymph nodes, or even a Meckel diverticulum may serve as lead points of the telescoped segment. Unlike in children, intussusception in an adult should always prompt a workup for bowel pathology.
Volvulus is often caused by adhesions or congenital anomalies such as intestinal malrotation. It more commonly occurs in the colon.
Strictures secondary to ischemia, inflammation (Crohn disease), radiation therapy, or prior surgery may cause obstruction.
Gallstone ileus occurs as a complication of cholecystitis. Fistulization between the biliary tree and the small bowel allows gallstones to travel distally and become lodged, typically at the ileocecal valve.
External compression from tumors, abscesses, hematomas, or other masses can cause functional SBO.
Foreign bodies typically pass without incident. Items presenting with obstruction may require operation if they cannot be retrieved endoscopically. Pathology due to swallowing foreign bodies is more common in institutionalized patients.
Embryology A. Origin The small intestine forms during the fourth week of fetal development. The duodenum arises from the foregut, and the jejunum and ileum derive from the fetal midgut. The endoderm forms the absorptive epithelium and the secretory glands. The splanchnic mesoderm gives rise to the rest of the […]