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Surgical department "SM-Clinic" on the street. Yaroslavskaya provides emergency surgical care around the clock.

The Department of Emergency Surgery at the SM-Clinic specializes in the treatment of acute surgical diseases of the abdominal cavity, such as:

• acute appendicitis,
• acute cholecystitis,
• strangulated hernias,
• perforated ulcers of the stomach and duodenum,
• acute pancreatitis,
• acute intestinal obstruction,
• peritonitis
• obstructive jaundice
• renal colic and some other diseases and conditions.

Some diseases of internal organs If not properly treated, they can cause serious complications and lead to death. Chronic diseases, accompanying the patient for more than one year, in some cases can also develop into an acute form. Such conditions require urgent hospitalization and emergency surgery.

There are a number of diseases that require urgent surgical treatment. Ignoring its necessity threatens with serious consequences for the patient, including death. Emergency surgical intervention is intended to prevent such situations.

Indications for emergency surgery

Health problems that require emergency surgical intervention can arise against the background of a chronic illness or quite suddenly. In any case, the need for surgery is indicated by characteristic clinical symptoms. These could be:

• severe pain;
• bleeding;
• loss of consciousness;
• convulsions.

Any of these symptoms is a good reason to urgently contact a medical facility. The sooner an accurate diagnosis is made by a doctor, the higher the patient’s chances of recovery. Self-medication in such situations is unacceptable, since it threatens with critical consequences for the body.

Types of emergency surgical operations

Urgent operations are most often performed for the following diagnoses: acute appendicitis and pancreatitis, perforated gastric ulcer, renal colic, ovarian rupture, etc. On the clinic website https://centr-hirurgii-spb.ru/ you can find the entire list of diseases, which require the emergency participation of surgeons. But you should always remember that in difficult cases, specialists have an extremely limited time interval to make decisions about performing an operation. Therefore, you should contact the clinic immediately after the obvious manifestation of a disturbing symptom.

In case of severe pain, bleeding or other dangerous symptoms, it is best to get help in medical institutions that have their own laboratory. Its presence allows the doctor to conduct a comprehensive examination of the patient in the shortest possible time, promptly make a reliable diagnosis and provide emergency surgical care.

The rehabilitation process after emergency and planned surgery is identical. After surgery, the patient is transferred to a ward in the inpatient department. There, under 24-hour medical supervision, he remains until discharge. The specifics of further recovery at home are determined by the type of disease, the extent of surgical intervention and the physical condition of the patient as a whole.

The concept of emergency surgery is spreading rapidly throughout the world. This is due to the desire to provide quality surgical treatment to the growing number of patients admitted to shock wards and trauma centers with life-threatening surgical diseases. Having originated from operative traumatology, emergency surgery very soon faced a large shortage of specialists capable of working in this area. The surgical world in Russia is filled with “narrow” specialists and elderly surgeons who have stopped working in emergency surgery departments. In Germany, on-site emergency surgeons are highly regarded for their availability, expertise and superior performance in treating surgical emergencies.

Although modern in name, the concept of emergency surgery, which relies on knowledgeable, well-trained, experienced specialists who are ready to provide qualified care for a wide range of emergency surgical diseases, is not new in content. In fact, it formed the basis of all training and practice in general surgery until the second half of the twentieth century. General surgeons have always been key specialists in emergency departments, ready to treat patients with acute abdomen, limb ischemia, soft tissue infections, trauma and a variety of other critical conditions.

Long before intensive care was recognized as a separate specialty, it was surgeons who provided emergency care to their patients. The concept of emergency surgical care replicates this type of practice but focuses on all emergency situations. Typically, the training program assumes that the emergency surgeon has expertise in trauma, critical care medicine, combustiology, and the vast majority of surgical emergencies. In addition, the concept of emergency surgical care has successfully integrated into the system of care, according to which the surgeon is ready and able to resuscitate, diagnose, operate and participate in the treatment of major surgical diseases.

By expanding the scope of responsibility of surgeons in traumatology and critical care medicine to include emergency surgery, as well as using the principles of evidence-based medicine, continuous analysis and improvement in order to achieve optimal results, a new surgical specialty has emerged. However, many clinical sites report very favorable experiences, improved clinical outcomes, increased patient satisfaction and cost-effectiveness.

As part of emergency surgery, assistance is provided in the following areas:

• - Acute appendicitis
• - Strangulated hernia
• - Acute intestinal obstruction
• - Acute cholecystitis
• - Perforated ulcer of the stomach and duodenum
• - Acute pancreatitis
• - Gastroduodenal bleeding of ulcerative etiology
• - Acute disturbance of mesenteric circulation
• - Peritonitis
• - Abdominal trauma
• - Acute gynecological diseases
• - Acute urological diseases

There are conditions called surgical diseases. This means that only surgery can save a person in this condition. This also means that delay is extremely dangerous. How to recognize problems when emergency surgical care is needed? The general rule is this: if you see that a person is very ill, call an ambulance and let the professionals sort it out. If the situation is very critical, then calling a surgeon at home can be a decisive factor.

Still, it's helpful to know the signs that surgery is needed. So, if a person falls or is simply seriously hurt, and his condition does not improve in the next half hour, but, on the contrary, worsens, then most likely we are talking about internal bleeding. Pay attention to symptoms such as dizziness, weakness, increasing pallor, dry mouth, especially after bruises of the chest or abdominal cavity, and, of course, the head.

All types of internal bleeding are dangerous and are a reason for urgent medical attention, even if there has been no previous injury. Perhaps a complication of some chronic disease has occurred, and emergency, and in some cases, planned surgical care is necessary. But what kind of operation is needed will be determined by the doctor, and your task is to notice the bleeding. So, sputum with blood, urine with blood or an unusual rusty color, feces with blood or a tarry appearance, bloody discharge from the vagina not associated with menstruation - all these are signs of internal bleeding.

Chronic diseases of internal organs, which have been sluggish for years, under certain circumstances can become aggravated and cause serious complications. Diseases such as calculous cholecystitis (cholelithiasis), pancreatitis, enterocolitis, gastric and duodenal ulcers, salpingo-oophoritis, appendicitis, tumors and some others can be complicated by peritonitis. Peritonitis is an inflammation of the peritoneum that, if left untreated, leads to death.

Another deadly condition is intestinal obstruction. The symptoms caused by these conditions are called “acute abdomen” and require immediate surgical attention. The main symptom is prolonged (more than 6 hours) intense pain in the abdomen; diarrhea and vomiting are also possible, which do not bring relief. Self-medication is unacceptable here; you cannot even give painkillers; you must urgently seek surgical help.

Well, another category is superficial injuries and burns, but here everything is in plain sight, so it’s difficult to make a mistake. Deep cuts, burns, frostbite, fractures - for all these conditions, surgical assistance must also be urgently provided

Genre: Surgery

Format: PDF

Quality:OCR

Description: The manual reflects the issues of organizing emergency surgical care for diseases and injuries of the abdominal organs, outlines the principles of their diagnosis, methods of surgical and conservative treatment. The main tasks that a surgeon must solve in case of a particular pathology of the abdominal organs are formulated, modern treatment and diagnostic algorithms are given, and key points are highlighted that a doctor providing assistance to this most difficult group of patients and victims must take into account.
For doctors undergoing retraining in abdominal surgery, surgical residents and 4th-6th year students of medical universities with a specialty in surgery.

The present and future of emergency abdominal surgery

Emergency abdominal surgery involves a wide range of diseases and injuries of the abdominal organs and retroperitoneal space with a high risk of mortality. Despite the different etiologies, acute surgical diseases and visceral trauma are based on bleeding, surgical infection, organ ischemia, intra-abdominal hypertension and organ dysfunction.

The prognosis for these pathological conditions worsens significantly if one deviates from the developed algorithms for their diagnosis and treatment, as well as with improper organization of medical and, in particular, surgical care. Good results in the treatment of emergency surgical diseases indicate a high level of development of healthcare in the state and its regions, since the morbidity and mortality from this pathology currently remain extremely high. For example, of the 51 million people who died worldwide in 2012, 17 million suffered from diseases that could be treated surgically.

The main trend in modern surgery is to reduce the invasiveness of surgical interventions. . The use of a step-by-step approach, consisting of differentiated tactics of using conservative treatment measures, minimally invasive interventions and, finally, laparotomy, allows us to provide an individualized approach to surgical patients and avoid unnecessary, extremely traumatic and sometimes crippling operations. An important role is given to minimally invasive methods of intervention: laparoscopic, intraluminal endoscopic, X-ray endovascular, percutaneous (under X-ray, ultrasound or CT navigation).

Of course, the most severe category of emergency patients are patients with peritonitis, septic shock, intra-abdominal hypertension syndrome, and severe blood loss. Treatment of these dangerous conditions requires impeccable mastery of general surgical procedures, blood-saving technologies, methods of staged management of an open abdomen, decompression of the abdominal cavity and methods of its closure. At the same time, the proportion of such severe patients in the structure of emergency surgical pathology is relatively small. In this regard, it is extremely important to use technologies aimed at reducing the aggression of surgical intervention. Modernization of surgical equipment and consistent training of surgeons in endovideo surgery skills over the past decade have led to a significant increase in the number of laparoscopic interventions.

Laparoscopic operations have become the method of choice in the treatment of acute appendicitis, acute cholecystitis and perforated ulcers. We can say that they have become part of routine surgical practice.

During this time, the methods of typical operations using endovideoscopic technology have been standardized, precise criteria for conversion have been adopted, and methods for such interventions have been developed for complicated forms of diseases. Surgeons have reached a “learning plateau.” One of the important achievements of the introduction of laparoscopy in the surgery of acute appendicitis was the reduction in the number of wasted appendectomies from 25-30% to 1-2%, since the discovery of an unchanged appendix with an open approach in most cases prompted the surgeon to perform an appendectomy in order to justify his actions.

Currently, experience is being accumulated and the possibilities of laparoscopic operations are being studied in the treatment of acute intestinal obstruction, strangulated hernia, widespread peritonitis, and abdominal trauma. The training period for this pathology is much longer, which is associated with more complex technical techniques. In addition, due to the lack of proven advantages of the laparoscopic approach, many surgeons are ambivalent about it.

Intraluminal diagnostic and therapeutic techniques nowadays they play a big role in the diagnosis and treatment of emergency diseases. Endoscopic hemostasis has become the leading method of stopping bleeding in the gastrointestinal tract. Surgical interventions under the control of endosonography are now available: sanitation of cavities and removal of sequesters in pancreatic necrosis through the posterior wall of the stomach, a wide range of transpapillary interventions in case of obstruction of the biliary tree, creation of anastomosis between the gallbladder and duodenum in acute cholecystitis if radical surgery is not possible. A relatively new method is the use of self-expanding stents to eliminate obstructions in various parts of the gastrointestinal tract, and when using covered stents (stent grafts) - to seal the lumen of hollow organs.

Percutaneous interventions under radiation control in the treatment of many urgent diseases play no less important role than laparoscopy. Thus, the use of percutaneous puncture and drainage has become the leading method of treating fluid accumulations in pancreatic necrosis, appendiceal abscesses, postoperative complications, and trauma. Puncture and drainage of the gallbladder are the leading methods of treating acute cholecystitis in patients with severe concomitant pathology and preparing them for radical surgery.

Endovascular interventions allow for hemostasis due to selective embolization of areas of extravasation from the vessels supplying blood to the pathological focus in ulcers, tumors and trauma, changing the usual treatment algorithms, allowing one to abandon laparotomy. Along with ultrasound, radiographic methods have become the navigation method for accessing the biliary tree for its unloading in hypertension.

The improvement of minimally invasive approaches and methods of conservative treatment creates algorithms in which the concept of a “non-operative” approach to the treatment of many emergency surgical diseases is increasingly important: ulcerative bleeding, trauma to parenchymal organs, pancreatic necrosis, intestinal obstruction, and a number of postoperative complications.

Currently, issues of replacing operations with conservative therapy, for example in acute appendicitis, are being considered. However, convincing data indicating the unconditional effectiveness of conservative therapy has not yet been obtained. Conservative treatment of appendicitis can be considered in case of extremely high risk of surgery, pregnancy, or categorical refusal of the patient. It is necessary to understand that the increase in the number of cases of non-operative treatment of surgical diseases requires close supervision of the surgeon and was made possible thanks to the round-the-clock availability of highly effective diagnostic methods - ultrasound, endoscopy, computed tomography and magnetic resonance imaging. Obviously, a patient with non-operative treatment of a surgical disease should be in a surgical hospital, since surgical treatment may be needed at any time, the line of indications between surgical and non-operative treatment is often blurred, which often leads to delays in operations and is fraught with a potential increase in diagnostic tests. errors.

Application of accelerated rehabilitation protocols in emergency surgery to date, little has been studied, but the interest of surgeons in this problem is growing. It is known that many options of a multimodal approach to accelerated rehabilitation are quite applicable to urgent surgery. Moreover, the introduction of laparoscopic operations into emergency surgery makes it possible to classify a number of patients into the category of those who can be treated in short-stay hospitals.

Prospects for the development of emergency abdominal surgery consist in developing the knowledge and skills of a surgeon focused on providing care to the most severe category of patients. Compliance with algorithms based on evidence-based recommendations is an important, but not the only factor in improving the results of treatment of urgent surgical diseases. The basis for the quality work of an “emergency surgeon” should be laid at the stages of proper training and modern organization of emergency surgical care.

The training of a general surgeon requires a clear orientation in endoscopy and interventional radiology, mastery of traditional and laparoscopic skills in hemostasis and intestinal suturing. He must be trained in basic surgical techniques, the use of staplers, and methods of staged management of an open abdomen.

This requires the creation of training programs that combine the acquisition of theoretical knowledge with the opportunity to develop practical skills in conditions close to real ones. This is possible thanks to the introduction of cadaver courses and work in operating rooms with laboratory animals on living tissues.

Organization of surgical care for sick and injured people should include reducing the time it takes for patients to be transported to the hospital, minimizing their stay in emergency departments, rapid triage and subsequent correct decision-making on diagnosis and treatment. The creation of specialized centers providing care to patients with trauma and emergency diseases shows their high efficiency. Meanwhile, today in Russia, due to difficult geographical and climatic conditions, it is not always possible to deliver a patient to a specialized hospital. That is why it is extremely important to adhere to the stages of surgical care, based on the elimination of life-threatening conditions and the subsequent transfer of the patient to a specialized stage (damage contlrol tactics).

We hope that the Guide offered to readers will serve as a kind of ABC for novice surgeons, and will allow experienced surgeons to abandon a number of familiar but obsolete dogmas, to a certain extent changing their views on emergency surgery.

"Emergency abdominal surgery"

ORGANIZATIONAL ISSUES

• Organization of emergency surgical care
• Features of the organization of assistance for abdominal injuries during terrorist attacks and military operations
• Accelerated rehabilitation in emergency abdominal surgery

BLEEDING

• Bleeding from the upper gastrointestinal tract
• Bleeding from the small and large intestine
• Intra-abdominal bleeding
• Rupture of an aneurysm of the abdominal aorta and its visceral branches
• Modern principles of blood loss replacement

ABDOMINAL SURGICAL SEPSIS

• Acute appendicitis
• Perforated ulcer of the stomach and duodenum
• Strangulated hernia
• Diffuse purulent peritonitis
• Principles of treatment of abdominal surgical sepsis

ACUTE INTESTINAL DISEASES

• Non-neoplastic mechanical intestinal obstruction
• Tumor obstruction of the colon
• Acute disorders of mesenteric circulation
• Complicated diverticular disease of the colon
• Non-tumor intestinal diseases in surgical practice

DISEASES OF ORGANS OF THE HEPATOPANCREATOBILIARY ZONE

• Acute cholecystitis
• Obstructive jaundice
• Cholangitis and liver abscesses
• Acute pancreatitis

ABDOMINAL TRAUMA

• Damage to hollow organs
• Rectal injuries
• Damage to parenchymal organs
• Pelvic hematomas: causes, consequences, surgical tactics
• Features of gunshot and mine-explosive abdominal trauma

POSTOPERATIVE COMPLICATIONS

• General issues of prevention of postoperative complications
• Treatment of surgical site infections
• Modern tactics of treatment of postoperative purulent intra-abdominal complications
• Principles of treatment of non-infectious intra-abdominal complications

SURGICAL PROBLEMS OF RELATED SPECIALTIES

• Acute gynecological diseases in the practice of a surgeon
• Acute abdomen in pregnant and postpartum women
• Acute abdomen in childhood
• Acute urological pathology in emergency surgical practice

buy manual:

Emergency surgical care may be required for conditions that threaten the patient's life. Conventionally, such conditions can be divided into two groups:

caused by external factors or trauma: abdominal trauma with a blunt object with rupture of internal organs, the presence of foreign bodies in the body;

arising under the influence of internal factors and complications of diseases: abscesses, phlegmon, appendicitis, peritonitis, etc.

How is emergency surgery performed?

Upon admission of a patient to the emergency surgery department of the Best Clinic, immediate preparation for surgery begins. The patient immediately undergoes the necessary tests, x-rays or ultrasound to reduce the risks of the operation.

Whenever possible, our specialists try to perform not abdominal, but laparoscopic surgery - mini-punctures in the place where surgical intervention is necessary. All operations are performed using advanced European and American equipment - for safe surgical interventions with minimal trauma.

Only high-quality drugs are used for anesthesia. The injection is given in the ward so that the patient is not bothered by the natural fear of the operation. And in the operating room there are monitors to measure the depth of anesthesia.

Rehabilitation

After the operation, the patient is observed in the hospital. The length of stay under observation depends on the complexity of the operation and the patient's condition.

At the Best Clinic inpatient facility, you will be under the 24-hour supervision of specialists and medical personnel. Each bed has a staff call button in case you need anything.

Upon discharge, the Best Clinic doctor will give detailed recommendations on the limitations of the recovery period.

The most important thing is to determine that a person needs emergency surgical care. Even if no damage is visible, but the person turns pale, feels worse and loses consciousness, it is necessary to urgently contact a medical facility.

The patient should not be given food or water until examined by a doctor.