How to deal with abdominal surgical complications

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: An ‘acute abdomen’ patient that is recovering from surgery may often have multiple and serious post-surgical complications. These complications are often due to a combination of surgery and the underlying disease process so management of these can be very challenging. The surgeon has to be well equipped to detect early deleterious changes in patient progress, whether this is bleeding, infection, leakage of bile or urine. This presentation therefore provides an overview of the most common post-surgical complications of these patients, how they can be diagnosed and practical ways to best treat them.

: Unfortunately, post-operative peritonitis is not unusual, intestinal surgery has about a 7% dehiscence rate and peritonitis may also be seen after other common abdominal procedures, including pyometra, prostatic surgery and cystotomy. Clinical signs of post-operative peritonitis can be difficult to differentiate from post-surgical ileus, pain and medication-related nausea or anorexia. About 50% of peritonitis cases may have concurrent pancreatitis. Imaging can be confusing as it is normal to have free fluid and gas in the abdomen after an open surgical approach (although the gas with peritonitis tends to be more diffuse). If free fluid is present on ultrasound, then sampling and performing cytology and peritoneal glucose and lactate concentration comparisons with serum levels can be most helpful. Other indications of peritonitis can include hypovolaemia, hypoproteinaemia (particularly a drop in albumin), development of respiratory acidosis and metabolic acidosis. Treatment involves intravenous antibiotics, haemodynamic support and repeat surgery to resolve the source of infection. Mortality rates are in the range of 20-50% depending on the study. Post-operative peritonitis does occur, and early detection may improve outcome. Careful monitoring after surgery and the use of a closed active suction drain in any cases that may be at higher risk may aid early detection. This presentation discusses risk factors in animals and prognostic indicators to guide decision making.

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