Acute abdominal and gastrointestinal surgical emergencies

image of Acute abdominal and gastrointestinal surgical emergencies
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Abdominal and gastrointestinal surgical emergencies include a diverse group of conditions that can be challenging to diagnose and manage successfully. This chapter describes the initial examination, patient evaluation and surgical and postoperative management of emergencies concerning the oesophagus, stomach, small intestine, large intestine, pancreas, biliary tract and peritoneum

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12.1 (a) Lateral and (b) dorsoventral abdominal radiographs of a dog with a small intestinal obstruction. Note the gas distension of several parts of the small intestine. The gas-filled descending duodenum is clearly visible on the lateral radiograph.
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12.2 (a) Lateral and (b) dorsoventral abdominal radiographs of a dog with pancreatitis. Radiographic signs suggestive of pancreatitis include: increased soft tissue opacity and decreased abdominal detail in the right cranial abdomen; a static, gas-filled descending duodenum; displacement of the pyloric antrum to the left; and displacement of the duodenum to the right, producing a widened angle between the stomach and the duodenum. (Courtesy of Dr HM Saunders, University of Pennsylvania School of Veterinary Medicine.)
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12.3 Lateral radiograph of a dog with gastric perforation, illustrating free gas in the peritoneal cavity. Note the diaphragm outlined clearly by the lungs cranially and the free peritoneal gas caudally.
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12.4 Lateral thoracic radiograph of a dog illustrating a thoracic oesophageal body present over the heart base. (Courtesy of Dr C Harvey, University of Pennsylvania School of Veterinary Medicine)
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12.5 Longitudinal oesophagotomy performed in the thoracic oesophagus to remove a fish hook. Stay sutures are used to retract the oesophageal wall. The incision is closed with a single layer of single interrupted sutures of 2 metric (3/0 USP) polydioxanone (PDS).
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12.6 Right lateral radiograph of a dog with gastric dilatation–volvulus. Note the appearance of the pylorus in the craniodorsal abdomen as a gas-filled structure.
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12.7 Incisional gastropexy with the cranial aspect of the incisions in the body wall and pyloric antrum sewn together.
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12.9 Intestinal resection and anastomosis completed. The anastomosis site has been wrapped in omentum.
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12.11 Diagrammatic representation of anastomosis of the small intestine to the large intestine. The large intestine has been oversewn so that its lumen approximates the size of the small intestine. The front is still to be sutured.
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12.12 Serosal patching. (a) Two healthy loops of small intestine are brought alongside the loop of bowel to be patched. Sutures are placed between the mesenteric side of the normal and affected intestine loops. (b) The antimesenteric surfaces of the two healthy loops of intestine are apposed with single interrupted sutures, covering the affected area with bowel. Note: this procedure should only be performed to reinforce healthy bowel. Patching does not remove the need for accurate assessment of bowel viability and resection of unhealthy bowel.
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12.13 Two closed suction drains, one placed in the cranial abdomen and one placed in the caudal abdomen, used to drain the peritoneal cavity after surgery for septic peritonitis.
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12.14 Open peritoneal drainage. The linea alba is sutured approximately 3 cm apart with non-absorbable material. This open incision is then covered with a sterile bandage that will require changing every 6–12 hours.
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12.15 Haemorrhagic splenic mass responsible for haemoperitoneum. Note the multiple masses in the omentum, suggesting local metastatic disease.
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