Textbook of Emergency General Surgery: Traumatic and Non-traumatic Surgical Emergencies

Description

This text aims to provide a comprehensive review of general emergency surgery, the branch of medicine that treats patients presenting to the hospital with a wide variety of emergency conditions. It includes a section focusing on clinical aspects, management, logistics, patient cohorts and perioperative considerations in the context of general emergency surgery and trauma. Other sections describe various conditions and diseases in specific anatomical structures to enable readers to easily find the information they need. Written and edited by international experts and opinion leaders in the field, this book is a valuable reference resource for general and emergency surgeons, trauma surgeons, emergency physicians and nurses. It will also be of interest to residents, students and all other healthcare professionals involved in the management of emergency surgical patients. Foreword Foreword Foreword Foreword Foreword Preface Contents Part I: General Consideration 1: History of Emergency General Surgery 1.1 Introduction 1.2 The Great Era of Surgery and the Origins of Emergency Model 1.3 Emergency Management in Modern Times 1.4 Future Perspectives of Acute Care Surgery 1.5 Conclusion References 2: General Approach to Emergency General Surgery 2.1 Introduction 2.1.1 Epidemiology 2.1.2 Etiology 2.1.3 Classification 2.1.4 Pathophysiology 2.2 Diagnosis 2.2.1 Clinical Presentation 2.2.1.1 History 2.2.2 Physical Examination 2.2.3 Tests 2.2.3.1 Imaging 2.3 Treatment 2.3.1 Medical Treatment 2.3.1.1 Trauma Victims: ABCDE 2.3.2 Surgical Treatment 2.3.3 Prognosis References 3: Evaluation of Traumatic and Nontraumatic Patients 3.1 Trauma Patient 3.1.1 Introduction 3.1.2 Diagnosis 3.1.3 Treatment 3.2 Nontraumatic Patient 3.2.1 Introduction 3.2.2 Diagnosis 3.2.3 Treatment References Further Reading 4: Prioritizing Acute Care Surgery and Trauma Patients 4.1 Introduction 4.2 Trauma 4.3 Emergency General Surgery References 5: Triage 5.1 Triage Scales 5.2 Triage in the ED 5.3 Pain Assessment at Triage 5.3.1 Triage Trauma Assessment 5.3.2 Triage Decision-Making 5.4 Triage for Imaging Studies 5.5 Triage to the Intensive Care Unit (ICU) 5.6 Triage in Mass Casualty Incidents (MCI) References Further Reading 6: Mass Casualties 6.1 Introduction 6.1.1 Terminology and Definitions 6.2 Diagnosis 6.2.1 Classification 6.2.1.1 Classification of Disasters 6.2.1.2 Natural Disasters 6.2.1.3 Technological Disasters 6.2.2 Disaster Cycle 6.3 Treatment 6.3.1 Medical Response to Mass Casualty Incidents 6.3.1.1 All Hazard Approach 6.3.1.2 Initial Actions at Scene 6.3.1.3 Command - Control 6.3.1.4 Safety 6.3.1.5 Communication 6.3.1.6 Assessment 6.3.1.7 Triage 6.3.1.8 Treatment 6.3.1.9 Transport 6.3.2 Medical Training for Mass Casualties References Further Reading 7: Point-of-Care Ultrasound for Emergency General Surgeons 7.1 Introduction 7.1.1 Point-of-Care Ultrasound Significance of Use for Emergency General Surgeons 7.1.2 Ultrasound Concepts and Principles 7.1.3 Transducers and Controls 7.2 Diagnosis: Pocus Daily Application for the Emergency General Surgeon 7.2.1 E-Fast and Rush 7.2.1.1 Practical Key Considerations Penetrating Cardiac Trauma Blunt Cardiac Trauma Performing the Pericardic Window Blunt Abdominal Trauma Penetrating Abdominal Trauma Chest Trauma: Hemothorax Chest Trauma: Pneumothorax Performing the Abdominal and Thoracic Windows 7.2.2 Heart 7.2.2.1 Performing the Cardiac Pocus Left Ventricular Longitudinal Parasternal Window (PLVE) or Long Axis Left Ventricular Transverse Parasternal Window (PTVE) or Short Axis Apical Window Subcostal Window Preload Evaluation Contractile Function Evaluation Assessment of the Right Ventricle Overload of Right Chambers in Pulmonary Embolism Cardiac Tamponade 7.2.3 Lungs 7.2.3.1 Performing Pulmonary Pocus 7.2.3.2 Normal Lung Bat Sign Pleural Slip, A-Lines, and Seashore Sign Lines B (Comet Tail) 7.2.3.3 Abnormal Findings: Pleural Effusion Sharp Signal and Sinusoidal Signal 7.2.3.4 Abnormal Findings: Alveolar Syndromes Flap Sign and Hepatization 7.2.3.5 Abnormal Findings: Interstitial Syndromes Lung Rocket Sign 7.2.3.6 Abnormal Findings: Pneumothorax Lung Point and Stratosphere Signal or Bar Code 7.2.4 Adding Point-of-Care Ecography and Lung Pocus in EGS Practice 7.2.4.1 Acute Respiratory Distress Evaluation The Blue Protocol 7.2.4.2 Shock Evaluation The Falls Protocol Obstructive Shock Cardiogenic Shock Hypovolemic Shock Distributive Shock 7.2.5 Vascular 7.2.5.1 Performing Vascular POCUS Sagittal (Transversal)/Longitudinal Plane Color Doppler Mode Assessment of Deep Venous Thrombosis (DVT) Cervical Zone Examination Technique Upper Limb Examination Technique Lower Limb Examination Technique Superficial Venous Thrombosis or Thrombophlebitis Abdominal Aortic Aneurysm 7.2.5.2 The IVC 7.2.6 Ocular Nerve Sheath (ONS) POCUS 7.2.6.1 Ocular Ultrasound and Assessment ONS 7.2.7 POCUS for Intra-abdominal Hypertension 7.2.8 Central Venous Access 7.2.8.1 Obtaining a Central Venous Access with POCUS 7.2.8.2 Dynamic Versus Static Technique 7.2.8.3 Internal Jugular Vein POCUS Access 7.2.8.4 Subclavian Vein POCUS Access 7.2.8.5 Femoral Vein POCUS Access 7.2.9 Paracentesis 7.2.9.1 Performing POCUS Paracentesis 7.2.10 Pericardiocentesis 7.2.10.1 Performing POCUS Pericardiocentesis 7.2.11 Thoracocentesis 7.2.11.1 Performing POCUS Thoracocentesis 7.2.12 Decision Making Assistance 7.2.13 Transversus Abdominal Plane (TAP) Block 7.2.14 POCUS-Guided Quadratus Lumborum Block References Further Reading 8: Systemic Response to Injury 8.1 Introduction 8.1.1 The Burden of Trauma 8.1.2 Physiological Effects of Trauma 8.2 Modern Concepts on Systemic Response to Trauma 8.2.1 Cellular Damage 8.2.2 Pro-inflammatory and Anti-inflammatory Responses 8.2.3 Mitochondria 8.2.4 Neutrophil Extracellular Traps 8.2.5 DNA 8.3 Patient Factors 8.3.1 Age 8.3.2 Genetic Predisposition 8.3.3 Co-morbidities 8.4 Surgical and Resuscitative Factors 8.4.1 Surgery 8.4.2 Medication 8.4.3 Traumatic Shock Resuscitation References Untitled 9: Coagulation and Thrombosis 9.1 Introduction 9.1.1 Epidemiology 9.1.2 Etiology 9.2 Pathophysiology 9.2.1 Early TIC 9.2.2 Late TIC 9.3 Diagnosis 9.3.1 Early TIC 9.3.2 Late TIC 9.4 Treatment References Further Reading 10: Septic Shock 10.1 Introduction 10.1.1 Definition of Sepsis and Septic Shock 10.1.2 Pathophysiology 10.1.3 Epidemiology 10.2 Diagnosis 10.2.1 Screening for Sepsis 10.2.2 The Place for Biomarkers 10.3 Management 10.3.1 Early Recognition 10.3.2 Early Management 10.3.2.1 Identification of the Source 10.3.2.2 Resuscitation SSC Guidelines Regarding Resuscitation Targets Fluid Resuscitation Vasoactive Agents Monitoring 10.3.3 Antimicrobial Therapy and Control of the Source of Infection 10.4 Prognosis 10.4.1 Mortality and Risk Factors 10.4.2 Long-term Outcomes 10.5 Conclusion References 12: Principles of Perioperative Management in Acute Care Surgery 12.1 Introduction 12.2 Shock Etiology 12.3 Priorities and Endpoints of Resuscitation 12.4 Primary Survey 12.4.1 Pulmonary 12.4.2 Cardiovascular 12.4.3 Renal 12.4.4 Gastrointestinal 12.4.5 Endocrine 12.4.6 Hematologic 12.4.7 Infectious References Further Reading 13: Critical Care Medicine 13.1 Introduction 13.2 Who Is the Critical Care Patient? 13.2.1 The Critical Emergency Surgery Patient 13.2.2 The Critical Trauma Patient 13.2.3 Stratification of Patients 13.3 What Is an ICU? 13.3.1 ICUs Models 13.3.2 ICUs Levels 13.3.3 ICU Workforce 13.3.3.1 Physicians 13.3.3.2 Nurses 13.3.3.3 Allied Health Care Professionals 13.3.4 ICU Service: Operational Requirement 13.4 General Principle of Management 13.4.1 Monitoring 13.4.1.1 Hemodynamic Monitoring 13.4.1.2 Respiratory Monitoring 13.4.1.3 Neurologic Monitoring 13.4.2 Organ Function Support 13.4.2.1 Respiratory Support 13.4.2.2 Ventilation Emergency General Surgery Intra-abdominal Hypertension Open Abdomen Trauma References Untitled 14: Fluid and Blood Management in Traumatic and Non-traumatic Surgical Emergencies 14.1 Introduction 14.2 Diagnosis: When to Administer Fluids? 14.3 Treatment: Choosing the Right Type of Fluid 14.3.1 Crystalloids 14.3.2 Colloids References 15: Compartment Syndrome 15.1 Introduction 15.2 Intracranial Compartment Syndrome 15.3 Orbital Compartment Syndrome 15.4 Thoracic and Mediastinal Compartment Syndrome [11–16] 15.5 Abdominal Compartment Syndrome [ACS] 15.5.1 Historical Background 15.5.2 Pathophysiology of ACS [16, 26–30] 15.5.2.1 Cardiovascular Effects 15.5.2.2 Pulmonary Dysfunction 15.5.2.3 Renal Sequelae 15.5.2.4 Abdominal Visceral Abnormalities 15.5.2.5 Abdominal Wall Abnormalities 15.5.2.6 Intracranial Derangements 15.5.3 Poly-compartment Syndrome [34, 35] 15.5.4 Recommendations in Management [23–25] 15.5.5 Quaternary ACS [46, 47] 15.6 Extremity Compartment Syndrome 15.6.1 Pathophysiology 15.6.1.1 Prevalence 15.6.1.2 Diagnosis 15.6.2 Problems in Treatment 15.6.2.1 Important Technical Aspects of Fasciotomy [90] 15.7 Miscellaneous Considerations [90] 15.7.1 Nonsurgical Treatment of ECS 15.7.2 Pediatric Acute Compartment Syndrome 15.7.3 Upper Extremity Compartment Syndrome [UECS] 15.7.4 Gluteal Compartment Syndrome 15.7.5 Thigh Compartment Syndrome 15.7.6 Foot Compartment Syndrome 15.8 Summary and Conclusions References 16: Antibiotic and Antimicotic Therapy 16.1 Introduction 16.2 Surgical Site Infection and Antibiotic Prophylaxis 16.2.1 Antibiotic Prophylaxis 16.2.1.1 Antibiotic Treatments Head and Neck Thorax Intra-abdominal Region Appendix Pancreas 16.2.1.2 Gallbladder and Bile Ducts 16.2.1.3 Small Intestine and Colon Stomach Orthopedics and Soft Tissue Infection 16.3 Antifungal Drugs 16.4 Diagnosis 16.5 Sepsis 16.6 Conclusion References 17: Pain Management 17.1 Introduction 17.1.1 Introduction 17.1.2 Pathophysiology of Pain 17.1.3 Special Patients Group 17.1.3.1 The Elderly Patient 17.1.3.2 The Pediatric Patient 17.1.3.3 The Obese Patient 17.1.3.4 Chronic Opiod Therapy: An Opiod Disorder 17.1.3.5 End of Life 17.2 Diagnosis: Assessment of Pain 17.3 Special Settings 17.3.1 Pain Management in the Prehospital Setting and in the Emergency Department 17.3.2 Acute Pain Service 17.3.3 Pain Management in Perioperative Care and in the Intensive Care Unit 17.3.4 Pain Management at Hospital Discharge 17.4 Treatment 17.4.1 Multimodal Pain Management 17.4.2 Non-pharmacological Pain Management 17.4.3 Pharmacological Analgesia 17.4.3.1 Paracetamol 17.4.3.2 NSAIDs 17.4.3.3 Ketamine 17.4.3.4 Opiods Morphine Fentanyl-Sufentanil-Remifentanil Oxycodone-Buprenorphine-Tramadol Local Anesthetics 17.4.4 Regional Analgesia References 18: Damage Control Surgery 18.1 Introduction 18.2 Diagnosis 18.2.1 Trauma Patients 18.2.2 Peritonitis 18.2.3 Vascular Emergencies 18.2.4 Pancreatitis 18.3 Treatment 18.3.1 Medical Treatment 18.3.2 Surgical Treatment 18.3.3 Prognosis References Further Reading 19: Nutritional Support 19.1 Introduction 19.2 Physiology of Nutrition in Trauma 19.3 Assessment of Malnutrition 19.4 Route of Nutrition: Enteral Vs Parenteral Nutrition 19.5 Timing and Site of Enteral Nutrition 19.6 Nutrition in the Open Abdomen 19.7 Nutrition Protocols 19.8 The Role of the Multidisciplinary Team in Nutritional Support 19.9 Areas of Future Work 19.10 Conclusion References Further Reading 20: Palliative Care in the ICU 20.1 Introduction 20.2 Establishing Definitions and A Common Language 20.2.1 The Need for Palliative Care 20.2.1.1 Economic Concerns and Impact 20.2.1.2 Barriers and Solutions to the Implementation of Palliative Care 20.2.1.3 REMAP 20.2.1.4 How and When to Implement Palliative Care 20.3 Integrative, Complementary, and Alternative Medicine 20.4 Spiritual Care 20.4.1 Palliative Intervention: Is There a Role? 20.4.2 Looking Forward: Changing Culture, Education and Research 20.5 Future Research Areas 20.6 Summary References 21: Immunosuppression in Surgical Patients 21.1 Introduction 21.2 Patients on Steroids 21.2.1 Summary 21.2.2 Secondary Adrenal Insufficiency 21.2.3 Surgical Stress 21.2.4 Diagnosis 21.2.5 Treatment 21.3 Transplanted Patients 21.3.1 Summary 21.3.2 Non-transplant Surgery 21.3.3 Diagnosis 21.3.4 Treatment 21.4 Patients with HIV/AIDS 21.4.1 Summary 21.4.2 Immune Function in HIV and AIDS Patients 21.4.3 Outcomes of Surgery 21.4.4 Perioperative Admission of HAART 21.4.5 Diagnosis 21.4.6 Treatment 21.5 Elderly 21.5.1 Summary 21.5.2 Immunosenescence in Elderly 21.5.3 Aging of the Population 21.5.4 Frailty 21.5.5 Most Common Emergency Surgeries 21.5.6 Diagnosis 21.5.7 Treatment 21.6 Malnutrition 21.6.1 Summary 21.6.2 Definition of Malnutrition 21.6.3 Patients at Risk for Malnutrition 21.6.4 Effects of Surgery 21.6.5 Diagnosis 21.6.6 Treatment 21.7 Malignancy 21.7.1 Summary 21.7.2 Immune Status 21.7.3 Abdominal Complications in Malignancy 21.7.4 Effect of Chemotherapy 21.7.5 Diagnosis 21.7.6 Treatment References 22: Pregnant Women 22.1 Introduction 22.2 Anatomic Changes in Pregnancy 22.3 Physiological Changes in Pregnancy 22.3.1 Body Fluid Homeostasis 22.3.2 Cardiovascular System 22.3.3 Respiratory System 22.3.4 Nutritional, Gastrointestinal, and Hepatobiliary Adaptations 22.3.5 Genitourinary System 22.3.6 Hematology and Coagulation 22.3.7 Adrenal Glands 22.3.8 Pancreas 22.3.9 Pituitary Gland 22.3.10 Thyroid Gland 22.3.11 Immunology 22.4 Surgical Emergency in Pregnant Women 22.5 Acute Abdomen in Pregnancy 22.6 Etiology and Incidence References 23: Geriatrics: Traumatic and Non-traumatic Surgical Emergencies 23.1 Introduction 23.2 Traumatic Surgical Emergencies 23.2.1 Traumatic Brain Injury 23.2.1.1 Diagnosis 23.2.1.2 Treatment 23.2.2 Thoracic Injuries 23.2.2.1 Diagnosis 23.2.2.2 Treatment 23.2.3 Intra-abdominal Hemorrhage and Solid Organ Injury 23.2.3.1 Diagnosis 23.2.3.2 Treatment 23.3 Non-traumatic Surgical Emergencies 23.3.1 Intra-abdominal Sepsis from Perforated Viscus (Diverticular and Peptic Ulcer Disease) 23.3.1.1 Diagnosis 23.3.1.2 Treatment 23.3.2 Acute Cholecystitis 23.3.2.1 Diagnosis 23.3.2.2 Treatment 23.3.3 Acute Mesenteric Ischemia 23.3.3.1 Diagnosis 23.3.3.2 Treatment References Further Reading 24: Pediatrics 24.1 Introduction 24.1.1 Epidemiology 24.1.2 Pediatric Emergency General Surgery 24.1.2.1 Pediatric Trauma 24.1.3 Etiology 24.1.3.1 Pediatric Emergency General Surgery Appendicitis Bowel Obstruction Meckel’s Diverticulum Inguinal Hernia 24.1.3.2 Pediatric Trauma 24.2 Diagnosis 24.2.1 Clinical Presentation 24.2.1.1 Pediatric Emergency General Surgery Appendicitis Bowel Obstruction Meckel’s Diverticulum Inguinal Hernia 24.2.1.2 Pediatric Trauma 24.2.2 Tests 24.2.2.1 Pediatric Emergency General Surgery Appendicitis Bowel Obstruction Meckel’s Diverticulum Inguinal Hernia 24.2.2.2 Pediatric Trauma 24.3 Treatment 24.3.1 Medical Treatment 24.3.1.1 Pediatric Emergency General Surgery Appendicitis Bowel Obstruction Meckel’s Diverticulum Inguinal Hernia Pediatric Trauma 24.3.2 Surgical Treatment 24.3.2.1 Pediatric Emergency General Surgery Appendicitis Bowel Obstruction Meckel’s Diverticulum Inguinal Hernia Pediatric Trauma 24.3.3 Prognosis References 25: Cirrhotic Patients 25.1 Introduction 25.1.1 Epidemiology 25.1.2 Etiology 25.1.3 Classification 25.1.4 Pathophysiology 25.1.4.1 Renal System 25.1.4.2 Cardiovascular System 25.1.4.3 Respiratory System 25.1.4.4 Central Nervous System 25.1.4.5 Coagulation System 25.2 Diagnosis 25.2.1 Clinical Presentation 25.2.2 Tests 25.2.3 Differential Diagnosis 25.3 Treatment 25.3.1 Medical Treatment 25.3.2 Surgical Treatment 25.3.3 Prognosis 25.3.3.1 Ascites 25.3.3.2 Hepatic Encephalopathy 25.3.3.3 Hepatorenal Syndrome 25.3.3.4 Variceal Hemorrhage 25.3.3.5 Venous Thromboembolism Prophylaxis References Further Reading 26: Management of Animal Bites: A Global Perspective 26.1 Introduction 26.1.1 Epidemiology 26.1.2 Animal Behavior and Biomechanism of Injury 26.1.3 Anatomical Regions of Injury 26.1.4 Infection of Bite Wounds 26.1.5 Bacteriology 26.2 Diagnosis 26.2.1 History and Physical Examination 26.2.2 Radiological Workups 26.2.3 Laboratory Investigations 26.3 Treatment 26.3.1 General Management 26.3.2 Local Wound Management 26.4 Psychological Impact 26.5 Injury Prevention References Selected References 27: Burns, Inhalation, and Lightning Injury 27.1 Introduction 27.1.1 Epidemiology 27.1.2 Etiology 27.1.3 Classification 27.1.4 Pathophysiology 27.2 Diagnosis 27.2.1 Clinical Presentation 27.2.1.1 In Hospital at the Emergency Department Management consist of the cABCDEffp protocol [6–10] starting with the Primary Survey c: Catastrophic Bleeding A: Airway and c-spine B. Breathing C. Circulation D. Disability E. Exposure 27.2.1.2 The Rule of 9 27.2.1.3 The Hand Rule 27.2.1.4 Lund and Browder 27.2.1.5 Depth of the Burn 27.2.1.6 Fluids Resuscitation 27.2.1.7 Myoglobinurea 27.2.1.8 Fahrenheit 27.2.1.9 Pain 27.2.1.10 First Option Without Intravenous Access 27.2.1.11 First Option with Venous or Intraosseous Access 27.2.1.12 Radiology 27.2.1.13 Secondary Survey 27.2.1.14 Non-accidental Burns 27.2.1.15 Toxic Gases Carbon Monoxide (CO) Cyanide Electrical Injury Low-Voltage Injury High-Voltage Injury Lightning Injury Management Note 27.3 “Acute” Surgical Treatment 27.3.1 Escharotomy 27.3.2 Fasciotomy 27.3.3 Surgical Treatment 27.3.3.1 Excision of the Burn Eschar 27.3.3.2 Skin Graft 27.3.3.3 Full-Thickness Grafts 27.3.3.4 Dermal Substitutes References 28: Blast: Mechanisms of Injury and Implications upon Treatment 28.1 Introduction 28.2 Mechanisms of Injury 28.2.1 Primary Blast Injury 28.2.1.1 Blast Lung Injury 28.2.1.2 Tympanic Membrane Perforation 28.2.1.3 Blast Intestinal Injury 28.2.1.4 Primary Blast Injury of Solid Organs 28.2.2 Secondary Blast Injury 28.2.3 Tertiary Blast Injury 28.2.4 Quarternary Blast Injury References 29: Major Bleeding Management and REBOA 29.1 Introduction 29.1.1 Epidemiology 29.1.1.1 History of REBOA 29.1.1.2 Trauma Patients 29.1.1.3 Acute Care Surgery 29.1.1.4 Obstetrical and Gynecologic Patients 29.1.2 Etiology 29.1.3 Classification 29.1.3.1 Hemorrhagic Shock 29.1.4 Pathophysiology 29.2 Diagnosis 29.2.1 Clinical Presentation 29.2.2 Tests 29.3 Treatment 29.3.1 Medical Treatment 29.3.2 Surgical Treatment of Hemorrhage 29.3.2.1 Timing 29.3.2.2 Complications References Further Reading 30: Robotics 30.1 Introduction 30.1.1 Historical Overview of Robotics in Surgery 30.1.2 Current Trends in Robotic Surgery 30.2 Robotics in Emergency Surgery 30.2.1 Background 30.2.2 Literature Reports 30.2.3 Advantages and Disadvantages of Robotic Emergency Surgery 30.3 Future Applications and Research Perspectives 30.3.1 Fluorescence-Based Surgery 30.3.2 Telemedicine 30.3.3 Artificial Intelligence in Surgery 30.3.4 Coming-Soon Technologies References Further Reading 31: Emergency and Trauma Surgery During Epidemia and Pandemia 31.1 Introduction 31.2 Personal Protective Equipment and Healthcare Workers’ Infection 31.3 Diagnosis: Emergency Surgery and Trauma Care During a Pandemic 31.4 Treatment: The Management of an Infected Patient for an Emergency Surgical Procedure after Admission 31.4.1 The Transfer of the Infected Patient to the Operating Room 31.4.2 The Operating Room Set Up 31.4.3 The Timing of Anesthesia 31.4.4 The Surgical Procedure 31.4.5 After the Surgical Procedure 31.4.6 The Postoperative Management and Discharge of the Patient References 32: Principles of Management of Surgical Complications 32.1 Introduction 32.2 Classification of Complications 32.2.1 Management of the Risk of the Complications 32.2.1.1 Prevention and Risk Assessment 32.2.1.2 Early Recognition 32.2.1.3 Appropriate and Timely Management of Complications 32.2.2 Common Surgical Complications in the Emergency Setting 32.2.2.1 Hemorrhage 32.2.2.2 Prevention 32.2.2.3 Diagnosis 32.2.3 Management 32.2.4 Postoperative Pain 32.2.4.1 Prevention 32.2.4.2 Diagnosis 32.2.4.3 Management 32.2.5 Fever 32.2.6 Respiratory Complications 32.2.6.1 Prevention 32.2.6.2 Diagnosis 32.2.7 Venous Thromboembolism 32.2.7.1 Prevention 32.2.7.2 Diagnosis 32.2.7.3 Management 32.2.8 Surgical Site Infections (SSIs) 32.2.9 Antibiotic Prophylaxis 32.2.9.1 Diagnosis 32.2.9.2 Management 32.3 Conclusion References 33: Iatrogenic Complications of Digestive Endoscopy 33.1 Introduction 33.1.1 Epidemiology 33.1.2 Pathophysiology 33.1.3 Other Complications of Digestive Endoscopy 33.1.3.1 Bleeding 33.1.3.2 Small Bowel Perforation 33.1.3.3 Endoscopic Stents and Instruments 33.1.3.4 Adverse Events of Percutaneous Endoscopic Enteral Access 33.1.3.5 Cardiopulmonary Adverse Events 33.1.3.6 Infectious Adverse Events 33.1.3.7 Other Adverse Events 33.2 Diagnosis 33.2.1 Clinical Presentation 33.2.1.1 Colonoscopy Perforations 33.2.1.2 Upper Digestive Endoscopy Perforations 33.2.2 Diagnostic Tests 33.2.2.1 Colonoscopy Perforations 33.2.2.2 Upper Digestive Endoscopy Perforations 33.3 Treatment 33.3.1 Medical Treatment 33.3.1.1 Colonoscopy Perforations 33.3.1.2 Upper Digestive Endoscopy Perforations 33.3.2 Surgical Treatment 33.3.2.1 Colonoscopy Perforations 33.3.2.2 Upper Digestive Endoscopy Perforations 33.3.3 Prognosis 33.3.3.1 Colonoscopy Perforations 33.3.3.2 Upper Digestive Endoscopy Perforations References Further Reading 34: End-of-Life Care, Including the Role of Intensive Care in Tissue and Organ Donation 34.1 End-of-Life Care in ICU 34.2 Organ and Tissue Donation 34.2.1 Brain Death and Organ Donation 34.3 Donation After Cardiac Death 34.4 Conclusion References 35: Futility of Care and Palliative Care 35.1 Introduction 35.2 The Medical Futility 35.3 Futility and Emergency Surgery 35.4 Challenges, Contrasts, and Their Resolution 35.5 Ethical Foundation and Ethical Implication of Futility 35.6 Palliative Care in Emergency Surgery References 36: Communication in Emergency General Surgery 36.1 Introduction 36.2 Communication as a Key Component of Teamwork in the OR 36.2.1 What Does Communication in the Perioperative Environment Entails? 36.2.2 External and Internal Determinants Causing Gaps in Communication 36.3 Introducing a Comprehensive Communication Model 36.3.1 Ten Proposals for Breaking the Communication Gap 36.3.2 The Role of Digital Technology and Digital Media 36.3.3 The COVID Experience or How Nonverbal Communication Counts Equally 36.4 Conclusion References Further Reading 37: Patient Safety and Risk Management 37.1 Introduction 37.1.1 Patient Safety 37.1.2 Patient Safety in Surgery 37.1.3 Patient Safety in Emergency General Surgery 37.1.4 Risk and Patient Safety 37.2 Diagnosis 37.2.1 Risk Assessment 37.3 Treatment 37.3.1 Risk Management and PS 37.3.2 Risk Management in Health Care 37.3.3 Risk Management in Surgery and Emergency General Surgery 37.3.4 COVID 19 and Patient Safety in Emergency General Surgery 37.3.5 Future of Emergency General Surgery and Patient Safety References 38: Quality Evaluation in Emergency General Surgery 38.1 Introduction 38.2 Context: Defining the Problem 38.3 Towards Quality EGS Care 38.3.1 Leadership 38.3.2 Patient Care 38.3.3 Emergency Surgical Team and Supporting Staff 38.3.4 Training 38.3.5 Patient Follow-Up, Benchmarking and Quality Initiatives 38.3.6 Designation of Emergency Surgical Services 38.4 EGS Registry 38.5 Emergency Surgery Outcomes Advancement Project (eSOAP) 38.6 Conclusion References Part II: Head, Face and Neck 39: Head and Brain Trauma 39.1 Introduction 39.2 Epidemiology 39.3 Pathophysiology 39.3.1 Intracranial Pressure and Cerebral Perfusion Pressure 39.4 Diagnosis 39.4.1 Imaging 39.4.1.1 Skull Fractures 39.4.1.2 Traumatic Subarachnoid Hemorrhage 39.4.1.3 Epidural Hematoma 39.4.1.4 Subdural Hematoma 39.4.1.5 Brain Contusions 39.4.1.6 Diffuse Axonal Injury 39.4.2 Neuromonitoring 39.4.2.1 Neurological Examination 39.4.2.2 ICP Monitoring 39.4.2.3 Brain Tissue Oxygenation Monitoring 39.5 Treatment 39.5.1 CSF Drainage with EVD 39.5.2 Osmotherapy 39.5.3 Hyperventilation 39.5.4 Metabolic Suppression (Barbiturate Coma) 39.5.5 Hypothermia 39.5.6 Decompressive Craniectomy 39.6 Traumatic Brain Injury in Polytrauma Patients References Suggested References 40: Emergency Surgical Access to the Neck 40.1 Introduction and Learning Goals 40.2 Surgical Anatomy of the Neck 40.2.1 Arteries 40.2.1.1 Carotid Arteries 40.2.1.2 Subclavian Artery 40.2.1.3 Vertebral Artery 40.2.2 Larynx and Trachea 40.2.3 Pharynx and Esophagus 40.3 Indications of Surgical Access to the Neck 40.3.1 Conditions 40.3.2 Diagnosis 40.3.3 When to Operate the Above-Mentioned Conditions 40.3.3.1 Trauma 40.3.3.2 Infection 40.4 Management 40.4.1 General Strategies in Trauma 40.4.2 Anterior Approach to the Sternocleidomastoid Muscle (ASCM) 40.4.2.1 Indication 40.4.2.2 Position 40.4.2.3 Technical Aspects 40.4.3 Supraclavicular Approach 40.4.3.1 Indication 40.4.3.2 Position 40.4.3.3 Technical Aspects 40.4.4 Sternotomy 40.4.4.1 Indication 40.4.4.2 Position 40.4.4.3 Technical Aspects 40.4.5 Anterior Thoracotomy 40.4.5.1 Indications 40.5 Simplified Approach to Particular Neck Injuries 40.5.1 Airway 40.5.1.1 Cricothyroidotomy Open Cricothyroidotomy Percutaneous Puncture Needle Cricothyroidotomy 40.5.1.2 Tracheostomy 40.5.2 Surgical Access to the  Esophagus 40.5.3 Arteries and Veins 40.5.3.1 Surgical Access to Carotid and Jugular Vein Injuries Carotid Injuries Vein Injuries 40.5.3.2 Surgical Access to Vertebral Artery Injuries 40.5.4 Infections Surgical Therapy References 41: Face and Neck Infections 41.1 Introduction 41.1.1 Epidemiology 41.1.2 Etiology 41.1.2.1 Origin of FNI: Primary Focus of Infection 41.1.2.2 Microbiology Microbiome of the Head and Neck Mucosal Spaces Microbiology in Face and Neck Infections 41.1.3 Classification 41.1.4 Pathophysiology 41.1.4.1 Odontogenic Infection Source 41.1.4.2 Tonsil Infection Source 41.1.4.3 Cervical Adenitis 41.2 Diagnosis 41.2.1 Clinical Presentation 41.2.2 Tests 41.2.2.1 Laboratory and Microbiological Tests 41.2.2.2 Diagnostic Imaging Tests Ultrasound Contrast Enhanced CT-Scan (CECT) Magnetic Resonance Imaging (MRI) 41.3 Treatment 41.3.1 Medical Treatment 41.3.1.1 Antibiotic Treatment 41.3.1.2 Assessment and Control of Airway 41.3.1.3 Additional Co-adjuvant Medical Treatments Corticosteroids Anticoagulation 41.3.2 Focus Control of Infection 41.3.2.1 Abscess of Canine, Buccal, Vestibular and Palatal Spaces 41.3.2.2 Masticator Space Abscess 41.3.2.3 Parotid Space 41.3.2.4 Debridement of the Floor of the Mouth: Ludwig Angina 41.3.2.5 Debridement of Central Compartment of the Neck. References Further Reading 42: Trauma to the Face 42.1 Introduction 42.1.1 Epidemiology 42.1.2 Etiology 42.1.3 Classification 42.2 Diagnosis 42.2.1 Clinical Presentation 42.2.2 Tests 42.3 Treatment 42.3.1 Medical Treatment 42.3.2 Treatment 42.3.3 Prognosis References Further Reading 43: Traumatic Neck Injuries 43.1 Introduction 43.1.1 Epidemiology 43.1.2 Etiology 43.1.3 Classification 43.1.3.1 Anatomy 43.1.4 Pathophysiology 43.2 Diagnosis 43.2.1 Clinical Presentation (Symptoms + Physical Findings) 43.2.1.1 Laryngotracheal Injuries 43.2.1.2 Esophageal Injuries 43.2.1.3 Vascular Injuries 43.2.1.4 Cervical Spine Injuries 43.2.2 Tests (Labs, Imaging) 43.3 Treatment 43.3.1 Medical Treatment (Interventional Radiology Included) 43.3.2 Surgical Treatment (Open and MIS Techniques) 43.3.2.1 Laryngotracheal Injuries 43.3.2.2 Esophageal Injuries 43.3.2.3 Vascular Injuries 43.3.3 Prognosis References Further Reading 44: Management of Neck Surgery Complications 44.1 Introduction 44.1.1 Epidemiology 44.1.2 Classification 44.2 Inferior Laryngeal Nerve Injury 44.2.1 Epidemiology 44.2.2 Etiology 44.2.3 Pathophysiology 44.2.4 Diagnosis 44.2.4.1 Clinical Presentation 44.2.4.2 Tests 44.2.5 Treatment 44.2.5.1 Medical Treatment 44.2.5.2 Surgical Treatment 44.2.6 Prognosis 44.3 Spinal Accessory Nerve Injury 44.3.1 Epidemiology 44.3.2 Etiology 44.3.3 Pathophysiology 44.3.4 Diagnosis 44.3.4.1 Clinical Presentation 44.3.4.2 Tests 44.3.5 Treatment 44.3.5.1 Medical Treatment 44.3.5.2 Surgical Treatment 44.4 Mandibular Branch of the Facial Nerve Injury 44.4.1 Epidemiology 44.4.2 Etiology 44.4.3 Pathophysiology 44.4.4 Diagnosis 44.4.4.1 Clinical Presentation 44.4.4.2 Tests 44.4.5 Treatment 44.4.5.1 Surgical Treatment 44.5 Phrenic and Vagus Nerve Injuries 44.6 Hypoparathyroidism 44.6.1 Epidemiology 44.6.2 Etiology 44.6.3 Pathophysiology 44.6.4 Diagnosis 44.6.4.1 Clinical Presentation 44.6.4.2 Tests 44.6.5 Treatment 44.6.5.1 Medical Treatment 44.7 Chyle Leak 44.7.1 Epidemiology 44.7.2 Etiology 44.7.3 Pathophysiology 44.7.4 Diagnosis 44.7.4.1 Clinical Presentation 44.7.4.2 Tests 44.7.5 Treatment 44.7.5.1 Medical Treatment 44.7.5.2 Surgical Treatment 44.8 Postoperative Haematoma 44.8.1 Epidemiology 44.8.2 Etiology 44.8.3 Pathophysiology 44.8.4 Diagnosis 44.8.4.1 Clinical Presentation 44.8.4.2 Tests 44.8.5 Treatment 44.9 Major Vessels Injury 44.9.1 Epidemiology 44.9.2 Etiology 44.9.3 Pathophysiology 44.9.4 Diagnosis 44.9.4.1 Clinical Presentation 44.9.4.2 Tests 44.9.5 Treatment 44.9.5.1 Medical Treatment 44.9.5.2 Surgical Treatment 44.10 Tracheomalacia 44.10.1 Epidemiology 44.10.2 Etiology 44.10.3 Pathophysiology 44.10.4 Diagnosis 44.10.4.1 Clinical Presentation 44.10.4.2 Tests 44.10.5 Treatment 44.10.5.1 Surgical Treatment 44.11 Laryngotracheal Complex Injuries 44.12 Pneumothorax 44.12.1 Epidemiology 44.12.2 Etiology 44.12.3 Pathophysiology 44.12.4 Diagnosis 44.12.4.1 Clinical Presentation 44.12.4.2 Tests 44.12.5 Treatment 44.12.5.1 Medical Treatment 44.12.5.2 Surgical Treatment 44.13 Injuries to the Cervical Oesophagus 44.14 Seroma and Wound Infection References Further Reading Part III: Thorax and Mediastinum 45: Emergency Surgical Access to the Thorax 45.1 Introduction 45.2 Diagnosis 45.3 Treatment 45.3.1 Anatomy of the Thorax 45.3.1.1 Thoracic Cavity 45.3.1.2 Thoracoabdominal Boundaries 45.3.1.3 Cardiac Box 45.3.1.4 Subclavian Artery Anatomy 45.3.2 Surgical Incisions 45.3.2.1 Best Approach Incision for Anatomic Injury 45.3.2.2 Finger or Tube Thoracostomy 45.3.2.3 Left Anterolateral Thoracotomy (Resuscitative Thoracotomy) 45.3.2.4 Bilateral Anterolateral Thoracotomy (Clam-Shell Thoracotomy) 45.3.2.5 Posterolateral Thoracotomy 45.3.2.6 Pericardial Window 45.3.2.7 Median Sternotomy 45.3.2.8 Left Subclavian Artery Injury 45.3.2.9 Right Subclavian Artery Injury References 46: Empyema 46.1 Introduction 46.2 Diagnosis 46.3 Treatment 46.3.1 Stage 1 (Exudative) 46.3.2 Stage 2 (Fibrinopurulent) 46.3.3 Stage 3 (Organized) 46.4 Special Considerations References Further Reading 47: Hemothorax and Pneumothorax 47.1 Introduction 47.1.1 Epidemiology 47.1.2 Etiology and Classification 47.1.2.1 Non-traumatic 47.1.2.2 Traumatic 47.1.3 Pathophysiology 47.2 Diagnosis 47.2.1 Clinical Presentation 47.2.2 Tests 47.3 Treatment 47.3.1 Medical Treatment 47.3.2 Surgical Treatment 47.3.2.1 Needle Decompression 47.3.2.2 Tube Thoracostomy 47.3.2.3 Chest Tube Size and Pigtail Catheters 47.3.2.4 Setup of the Pleur-evac or Atrium 47.3.2.5 Heimlich Valves 47.3.2.6 Thoracotomy and VATS for Hemothorax Evacuation 47.3.2.7 VATS Pleurodesis 47.3.2.8 Post-surgical Management 47.3.3 Prognosis and Complications 47.3.3.1 Tube Thoracostomy Complications 47.3.3.2 Persistent Air Leak 47.3.3.3 Tracheobronchial Injury References 48: Chest Trauma 48.1 Introduction 48.1.1 Epidemiology 48.1.2 Etiology 48.1.3 Classification 48.1.4 Pathophysiology 48.2 Diagnosis 48.2.1 Clinical Presentation (Sxs and Phys Exam) 48.2.2 Tests (Labs, Imaging) 48.3 Treatment 48.3.1 Medical Treatment (Including IR) 48.3.1.1 Immediate Treatment 48.3.1.2 Ongoing Medical Treatment Considerations 48.3.2 Surgical Treatment (Incl Open and MIS) 48.3.2.1 Emergency Department 48.3.2.2 Operating Room Chest Wall Injury Lung Injury Tracheobronchial Injury Diaphragm Injury 48.3.3 Prognosis (Incl Complications and Their Management) 48.3.3.1 Complications References Further Reading 49: Thoracic Vascular Trauma 49.1 Introduction 49.1.1 Epidemiology 49.1.2 Etiology 49.1.2.1 Penetrating Trauma 49.1.2.2 Blunt Trauma 49.1.3 Classification 49.1.3.1 Aorta Penetrating Blunt 49.1.3.2 Arch Vessels Penetrating Blunt 49.1.3.3 Pulmonary Vessels Penetrating Blunt 49.1.3.4 Vena Cava Penetrating Blunt 49.1.3.5 Chest Wall Vessels Penetrating Blunt 49.1.4 Pathophysiology 49.2 Diagnosis 49.2.1 Clinical Presentation 49.2.1.1 Penetrating 49.2.1.2 Blunt Trauma 49.2.2 Tests 49.3 Treatment 49.3.1 Medical Treatment 49.3.2 Surgical Treatment 49.3.2.1 Aorta Penetrating Blunt Endovascular Repair 49.3.2.2 Arch Vessels Penetrating Blunt Endovascular Repair 49.3.2.3 Pulmonary Vessels Penetrating Blunt 49.3.2.4 Vena Cava Penetrating Blunt 49.3.2.5 Chest Wall Vessels Penetrating Blunt 49.3.3 Prognosis References Further Reading 50: Resuscitative Thoracotomy 50.1 Introduction 50.1.1 Definitions of Resuscitative Thoracotomy 50.1.2 Historical Perspective 50.1.3 Objectives of Resuscitative Thoracotomy 50.2 Diagnosis 50.2.1 Assessment of the Trauma Patient 50.2.2 Indications for Resuscitative Thoracotomy 50.3 Pathophysiology 50.3.1 Pericardial Tamponade 50.3.2 Intrathoracic Hemorrhage 50.3.3 Bronchovenous Air Embolism 50.3.4 Open Cardiac Massage 50.3.5 Thoracic Aortic Cross-Clamping 50.4 Treatment 50.4.1 Surgical Technique 50.4.1.1 Thoracic Incision 50.4.1.2 Pericardiotomy and Cardiac Hemorrhage Control 50.4.1.3 Thoracic Aortic Occlusion and Pulmonary Hilar Control 50.4.1.4 Cardiac Massage and Advanced Cardiac Life Support (ACLS) Interventions 50.4.1.5 Markers of Futility 50.4.1.6 Definitive Surgery 50.4.2 Technical Complications 50.4.3 Medical Optimization Following RT 50.4.4 Prognosis 50.4.5 Risks to the Trauma Team 50.4.6 Selective Application of Resuscitative Thoracotomy References Further Reading 51: Cardiac Trauma and Tamponade 51.1 Introduction 51.1.1 Epidemiology 51.1.1.1 Blunt Cardiac Injury 51.1.1.2 Penetrating Cardiac Injury 51.1.2 Etiology 51.1.3 Classification 51.1.4 Pathophysiology 51.2 Diagnosis 51.2.1 Clinical Presentation 51.2.1.1 PCI and the “Cardiac Box” 51.2.2 Tests 51.2.2.1 Electrocardiogram (ECG) 51.2.2.2 Laboratory Tests—Cardiac Biomarkers 51.2.2.3 Radiologic Tests 51.2.2.4 Ultrasound and eFAST Exam 51.2.2.5 Echocardiography 51.2.2.6 Computed Tomography Scan 51.2.2.7 Magnetic Resonance Imaging 51.3 Treatment 51.3.1 Medical Treatment 51.3.2 Surgical Treatment 51.3.3 Prognosis References Further Reading 52: Management of Cardiothoracic Surgery Complications 52.1 Perioperative Complications in Thoracic Surgery 52.1.1 Introduction 52.1.2 Diagnosis and Treatment 52.2 Perioperative Complications in Cardiac Surgery 52.2.1 Introduction 52.2.2 Diagnosis and Treatment 52.2.2.1 The Main Cardiovascular Complications during the Intensive Treatment Phase Myocardial Stunning Low Cardiac Output Syndrome Postoperative Bleeding Cardiac Tamponade Myocardial Infarction Cardiac Rhythm Disorders PostPerfusion Syndrome 52.2.2.2 The Main Noncardiovascular Complications During the Intensive Treatment Phase Anemia and Blood Products 52.2.2.3 Heparin-Induced Thrombocytopenia Fever Sternal Instability and Mediastinitis Acute Kidney Failure Gastrointestinal Complications Nonocclusive Mesenteric Ischemia and Ischemic Cholecystitis (NOMI) Abdominal Bleeding Hyperbilirubinemia and Hepatic Injury Neurological Disorders Postoperative Delirium (POD) References 53: Acute Congenital and Acquired Heart Disease 53.1 Introduction 53.2 Acute Aortic Syndromes 53.3 Clinical Symptoms and Signs 53.4 Classification 53.5 Technique of Ascending Aorta and Arch Replacement 53.6 Mechanical Complications of Acute Myocardial Infarction 53.6.1 Ventricular Septal Rupture 53.6.2 Rupture of Left Ventricle Free Wall 53.6.3 Papillary Muscle Rupture and Acute Mitral Regurgitation 53.7 Critical Congenital Heart Disease 53.7.1 Hypoplastic Left Heart Syndrome (HLHS) 53.7.2 Transposition of Great Arteries (TGA) 53.7.3 Obstructed Total Pulmonary Vein Connection (oTPVC) 53.7.4 Aortic Coarctation (CoAo) References Further Reading Part IV: Abdomen 54: Principles of Emergency and Trauma Laparotomy 54.1 Introduction 54.1.1 Epidemiology 54.1.2 Etiology 54.1.2.1 Medical or Non-traumatic Situations [9–11] 54.1.2.2 Traumatic Situations 54.2 Classifications 54.2.1 Physiopathology 54.2.1.1 Hemorrhagic Shock: Stop the Bleeding et Limit the Contamination 54.2.1.2 Acute Peritonitis: Control the Sepsis and Prevent Abdominal Hyper Pressure 54.3 Diagnosis 54.3.1 Clinical Presentation 54.3.2 Tests 54.3.2.1 Imaging 54.3.2.2 Lab Tests 54.4 Treatment 54.4.1 Medical Treatment 54.4.1.1 Preoperative Management 54.4.1.2 Postoperative Management 54.4.1.3 Arterial Embolization 54.4.2 Surgical Treatment 54.5 Prognosis 54.1.1 References 55: Principles of Emergency and Trauma Laparoscopy 55.1 Introduction 55.2 Diagnosis 55.3 Indications and Contraindications of Laparoscopy in Surgical Emergencies 55.3.1 Acute Appendicitis 55.3.2 Acute Cholecystitis 55.3.3 Acute Pancreatitis 55.3.4 Perforated Peptic Ulcer 55.3.5 Acute Mesenteric Ischemia 55.3.6 Acute Diverticulitis 55.3.7 Small Bowel Obstruction Due to Adhesions 55.3.8 Incarcerated/Strangulated Hernias 55.3.9 Gynecological Disorders 55.4 Surgical Imaging and Assistance in Emergency Laparoscopy Setting 55.4.1 Indocyanine Green Fluorescence 55.4.2 X-Ray and Fluoroscopy Guidance 55.4.3 Endoscopy and Surgery 55.5 Indications and Contraindications of Laparoscopy in Traumatic Emergencies 55.5.1 Indications for Exploratory Laparoscopy in Abdominal Trauma 55.5.2 Contraindications for the Use of Laparoscopy in Trauma 55.6 Treatment 55.7 Basics in Laparoscopic Surgery for Trauma 55.7.1 Basic Equipment 55.7.2 The Operating Room 55.7.3 Laparoscopic Instruments 55.7.4 Basic Technique 55.7.5 Entry Techniques 55.7.6 Trocar Placement 55.8 Important Issues About Laparoscopy in Trauma Patients 55.8.1 Critical Points to Conversion 55.9 Technical Aspects of SELT Procedure 55.9.1 Ready Check list Description 55.10 Summary References 56: Esophageal Non-traumatic Emergencies 56.1 Introduction 56.1.1 Anatomy 56.1.2 Background 56.2 Clinical Presentation and Diagnosis 56.2.1 Esophageal Perforation 56.2.2 Foreign Body Ingestion 56.2.3 Complications of Esophageal Surgery 56.2.4 Descending Necrotizing Mediastinitis 56.2.5 Esophageal Bleeding 56.3 Treatment 56.3.1 Perforations 56.3.2 Foreign Body Ingestion 56.3.3 Complications of Esophageal Surgery 56.3.4 Descending Necrotizing Mediastinitis 56.3.5 Esophageal Bleeding References Further Reading 57: Esophageal Trauma 57.1 Introduction 57.1.1 Epidemiology and Etiology 57.1.2 Classification 57.2 Diagnosis 57.2.1 Clinical Presentation and Investigations 57.3 Medical Treatment 57.4 Surgical Treatment References 58: Caustic Ingestion 58.1 Introduction 58.2 Epidemiology 58.3 Corrosive Agents 58.4 Emergency Management 58.4.1 Prehospital Management 58.4.2 In Hospital Management 58.4.3 Evaluation of Digestive Caustic Injuries 58.4.3.1 Symptoms 58.4.3.2 Laboratory Studies 58.4.3.3 Computed Tomography 58.4.3.4 Endoscopy 58.4.4 Injury Directed Management 58.4.4.1 Non-operative Treatment 58.4.4.2 Emergency Surgery Oesophagogastrectomy (OGT) Gastrectomy Extended Resections Tracheobronchial Necrosis (TBN) Results of Emergency Surgery 58.5 Conclusion References 59: Surgical Jaundice and Cholangitis 59.1 Introduction 59.1.1 Epidemiology 59.1.2 Etiology 59.1.3 Classification 59.1.4 Pathophysiology 59.2 Diagnosis 59.2.1 Clinical Presentation 59.2.2 Tests 59.3 Treatment 59.3.1 Medical Treatment 59.3.1.1 Cardiopulmonary 59.3.1.2 Renal 59.3.1.3 Nutrition 59.3.1.4 Coagulation 59.3.1.5 Grade I (Mild Acute Cholangitis) 59.3.1.6 Grade II (Moderate Acute Cholangitis) 59.3.1.7 Grade III (Severe Acute Cholangitis) 59.3.2 Surgical Treatment 59.3.3 Prognosis References Further Reading 60: Biliary Colic and Acute Cholecystitis 60.1 Introduction 60.1.1 Epidemiology 60.1.2 Etiology 60.1.3 Classification 60.1.4 Pathophysiology 60.2 Diagnosis 60.2.1 Clinical Presentation 60.2.2 Tests 60.2.3 Diagnostic Criteria 60.3 Treatment 60.3.1 Biliary Colic 60.3.2 Acute Cholecystitis 60.3.3 Common Bile Duct Stones Associated with Acute Cholecystitis References Further Reading 61: Hepatic Abscesses 61.1 Introduction 61.1.1 Epidemiology 61.1.2 Etiology 61.1.3 Classification 61.1.4 Pathophysiology 61.2 Diagnosis 61.2.1 Clinical Presentation 61.2.2 Tests 61.3 Treatment 61.3.1 Medical Treatment 61.3.2 Surgical Treatment 61.3.3 Prognosis References Further Reading 62: Spleen Non-traumatic Acute Surgical Conditions 62.1 Splenic Abscess 62.1.1 Epidemiology 62.1.2 Etiology 62.1.3 Classification 62.1.4 Pathophysiology 62.1.5 Diagnosis 62.1.5.1 Clinical Presentation 62.1.5.2 Tests 62.1.6 Treatment 62.1.6.1 Medical Treatment 62.1.6.2 Surgical Treatment 62.1.6.3 Prognosis 62.2 Atraumatic/Pathologic Splenic Rupture 62.2.1 Epidemiology 62.2.2 Etiology and Pathophysiology 62.2.3 Classification 62.2.4 Diagnosis 62.2.4.1 Clinical Presentation 62.2.4.2 Tests 62.2.5 Treatment 62.2.5.1 Medical Treatment 62.2.5.2 Surgical Treatment 62.2.5.3 Prognosis 62.3 Splenic Artery Aneurism 62.4 Postsplenectomy Management References Further Reading 63: Acute Adrenal Conditions: Pheochromocytoma Emergencies 63.1 Introduction 63.1.1 Epidemiology 63.1.2 Etiology 63.1.3 Classification 63.1.4 Pathophysiology 63.2 Diagnosis 63.2.1 Clinical Presentation 63.2.1.1 Multisystemic Failure 63.2.1.2 Hypertensive Crisis 63.2.1.3 Hypotension and Cardiogenic Shock 63.2.1.4 Arrhythmias 63.2.1.5 Acute Coronary Syndrome 63.2.1.6 Myocarditis and Cardiomyopathy 63.2.1.7 Pulmonary Edema 63.2.1.8 Gastrointestinal, Nephrological, and Neurological Emergencies 63.2.2 Tests 63.2.2.1 Biochemical Tests 63.2.2.2 Imaging Studies 63.3 Treatment 63.3.1 Preoperative Management 63.3.2 Intra-Operative Management 63.3.3 Medical Treatment 63.3.4 Surgical Treatment 63.3.5 Prognosis References 64: Nontraumatic Liver Hemorrhage 64.1 Introduction 64.1.1 Epidemiology 64.1.2 Etiology and Classification 64.2 Common Principles in Diagnosis and Management 64.2.1 Clinical Presentation 64.2.2 Laboratory Testing 64.2.3 Imaging 64.2.4 Management 64.3 Etiologies of NLH 64.3.1 Benign Hepatic Lesions 64.3.1.1 Hepatic Adenoma 64.3.1.2 Hepatic Cyst 64.3.1.3 Focal Nodular Hyperplasia (FNH) 64.3.1.4 Hemangioma 64.3.1.5 Nodular Regenerative Hyperplasia (NRH) 64.3.1.6 Biliary Cystadenoma 64.3.1.7 Angiomyolipoma (AMLs) 64.3.2 Malignant Hepatic Lesions 64.3.2.1 Hepatocellular Carcinoma (HCC) 64.3.2.2 Angiosarcoma 64.3.2.3 Epithelioid Hemangioendothelioma (EHE) 64.3.2.4 Hepatoblastoma 64.3.2.5 Rhabdoid Sarcoma 64.3.2.6 Metastatic Disease to the Liver 64.3.3 Vascular/Autoimmune/Connective Tissue 64.3.3.1 Peliosis Hepatis 64.3.3.2 Amyloidosis 64.3.3.3 Systemic Lupus Erythematosus (SLE) 64.3.3.4 Polyarteritis Nodosa and Other Vasculitides 64.3.4 Obstetric Hepatic Disease 64.3.4.1 Hemolysis, Elevated Liver Enzymes, and Low Platelets (HELLP) Syndrome 64.3.4.2 Acute Fatty Liver of Pregnancy References 65: Acute Pancreatitis 65.1 Introduction 65.1.1 Epidemiology 65.1.2 Etiology 65.1.3 Classification 65.1.4 Pathophysiology 65.2 Diagnosis 65.2.1 Clinical Presentation 65.2.2 Tests 65.3 Treatment 65.3.1 Medical Treatment 65.3.2 Surgical Treatment 65.3.2.1 Infected Pancreatic Necrosis (IPN) 65.3.2.2 Disconnected Duct Syndrome (DDS) 65.3.2.3 Abdominal Compartment Syndrome (ACS) 65.3.2.4 Gastrointestinal Perforations and Fistulas 65.3.2.5 Gangrenous Cholecystitis 65.3.2.6 Acute Bleeding or Pseudoaneurysm 65.3.2.7 Gastric Outlet Obstruction (GAO) 65.3.3 Prognosis 65.3.3.1 Complications 65.3.4 Mortality References Further Reading 66: Acute Appendicitis 66.1 Introduction 66.1.1 Epidemiology 66.1.2 Etiology, Pathophysiology, and Classification 66.2 Diagnosis 66.2.1 Clinical Presentation, Tests, and Differential Diagnosis 66.2.2 Imaging 66.3 Treatment 66.3.1 Nonoperative 66.3.2 Surgical Treatment 66.3.3 Prognosis References Suggested Reading 67: Acute Left Colonic Diverticulitis 67.1 Introduction 67.2 Classifications 67.3 Diagnosis 67.4 Treatment of Uncomplicated ALCD 67.5 Treatment of Diverticular Abscess 67.6 Treatment of Diverticular Peritonitis 67.7 Conclusions References 68: Acute Mesenteric Ischemia 68.1 Introduction 68.1.1 Epidemiology 68.1.2 Etiology and Classification 68.1.3 Pathophysiology 68.2 Diagnosis 68.2.1 Clinical Presentation 68.2.2 Tests 68.2.2.1 Laboratory Diagnosis 68.2.3 Imaging Techniques 68.3 Treatment 68.3.1 Therapeutic Approaches 68.3.2 Surgical Options 68.3.2.1 Surgical Approach to the Superior Mesenteric Artery (SMA) 68.3.2.2 SMA Grafting 68.3.2.3 Retrograde Stenting in Case of Atheromatous Ostial Disease 68.3.3 Endovascular Techniques 68.4 Diagnosis and Treatment of NOMI 68.4.1 Mesenteric Venous Thrombosis (MVT) References 69: Upper Gastrointestinal Bleeding 69.1 Introduction 69.1.1 Epidemiology 69.1.2 Etiology 69.1.3 Classification 69.1.4 Pathophysiology 69.1.4.1 Peptic Ulcer Disease (PUD) 69.1.4.2 Mallory-Weiss Syndrome 69.1.4.3 Stress Gastritis 69.1.4.4 Variceal Bleeding 69.1.4.5 Other Causes of UGIB 69.2 Diagnosis 69.2.1 Clinical Presentation 69.2.2 Test 69.3 Treatment 69.3.1 Workup and Initial Treatment 69.3.1.1 Hemodynamic Assessment and Resuscitation 69.3.1.2 Blood Transfusion 69.3.1.3 Risk Assessment 69.3.2 Medical Treatment 69.3.2.1 Pre-endoscopic Medical Treatment 69.3.2.2 Endoscopy 69.3.2.3 Interventional Radiology 69.3.3 Surgical Treatment 69.3.4 Follow-Up References Further Reading 70: Gastric Outlet Obstruction 70.1 Introduction 70.1.1 Epidemiology 70.1.2 Etiology 70.1.2.1 Mechanical Obstruction (Table 70.1) 70.1.2.2 Motility Disorders (Table 70.2) 70.1.2.3 Congenital Malformation (Table 70.2) 70.1.3 Classification 70.1.4 Pathophysiology 70.2 Diagnosis 70.2.1 Clinical Presentation 70.2.2 Tests 70.2.2.1 Laboratory Test 70.2.2.2 Imaging 70.2.2.3 Endoscopy 70.3 Treatment 70.3.1 Medical Treatment 70.3.1.1 Endoscopic Balloon Dilation (EBD) 70.3.1.2 Self-Expanding Metal Stents (SEMS) 70.3.1.3 Lumen-Apposing Metal Stents (LAMS) 70.3.2 Surgical Treatment 70.3.3 Chinese Medicine Treatment: Acupuncture 70.3.4 Prognosis References 71: Acute Lower Gastrointestinal Bleeding 71.1 Introduction 71.1.1 Aetiology of Lower GI Bleeding 71.2 Diagnosis 71.2.1 Clinical Presentation and History Taking 71.2.2 Initial Investigation 71.3 Treatment 71.3.1 Medical Treatment 71.3.1.1 Blood Transfusion and Correction of Coagulopathy 71.3.1.2 Tranexamic Acid (TXA) 71.3.1.3 Anticoagulation and Antiplatelet Medications 71.3.1.4 Warfarin 71.3.1.5 Direct Oral Anticoagulants (DOAC) 71.3.1.6 Aspirin 71.3.1.7 Dual Antiplatelet Therapy (DAPT) 71.3.1.8 Management Algorithm and Severity Stratification 71.3.1.9 Risk Scoring Systems in Lower GI Bleeding The Oakland Score The Birmingham Score 71.3.1.10 Investigations and Treatments 71.3.1.11 Upper GI Endoscopy 71.3.2 Radiology 71.3.2.1 Computer Tomography Angiography (CTA) 71.3.2.2 Role of Interventional Radiology 71.3.2.3 Nuclear Scintigraphy 71.3.2.4 Video Capsule Endoscopy (VCE) and Small Bowel Enteroscopy 71.3.2.5 Lower GI Endoscopy 71.3.3 Surgical Treatment 71.3.4 Damage Control Surgery 71.4 Summary of Management References Further Reading 72: Perforated Peptic Ulcer 72.1 Introduction 72.1.1 Epidemiology 72.1.2 Etiology 72.1.2.1 Helicobacter pylori 72.1.2.2 Nonsteroidal Anti-inflammatory Drugs 72.1.2.3 Cigarette Smoking 72.1.2.4 Marginal Ulcer 72.1.3 Pathogenesis 72.2 Diagnosis 72.2.1 Clinical Presentation 72.2.2 Investigations 72.2.2.1 Serum Investigations 72.2.2.2 Imaging 72.3 Management 72.3.1 Resuscitation 72.3.2 Scoring Systems in PPU 72.3.3 Surgical Treatment 72.3.3.1 Open Surgery 72.3.3.2 Laparoscopic Surgery 72.3.3.3 Endoscopic Interventions 72.3.4 Nonoperative Management 72.3.5 Prognosis References Further Reading 73: Diagnosis and Management of Acute Small Bowel Obstruction 73.1 Introduction 73.1.1 Epidemiology 73.1.2 Etiology 73.1.2.1 Etiology in the Virgin Abdomen 73.1.3 Classification 73.2 Diagnosis 73.2.1 Clinical Presentation 73.2.2 Investigations and Imaging 73.3 Treatment 73.3.1 Non-operative Treatment 73.3.2 Surgical Treatment 73.3.3 Prognosis References Further Reading 74: Small Bowel Perforation 74.1 Introduction 74.1.1 Epidemiology 74.1.2 Aetiology 74.1.3 Classification 74.1.4 Pathophysiology 74.2 Diagnosis 74.2.1 Clinical Presentation 74.2.2 Tests 74.3 Treatment 74.3.1 Medical Treatment 74.3.2 Surgical Treatment 74.3.3 Prognosis References 75: Small Bowel Diverticular Disease 75.1 Introduction 75.1.1 Epidemiology 75.1.2 Etiology 75.1.3 Classification 75.1.4 Pathophysiology 75.2 Diagnosis 75.2.1 Clinical Presentation 75.2.2 Tests 75.2.2.1 Labs 75.2.2.2 Conventional Radiology 75.2.2.3 Ultrasound (US) 75.2.2.4 MDCT Scans 75.2.2.5 MRI Findings 75.2.2.6 Scintigraphy 75.3 Treatment 75.3.1 Medical Treatment 75.3.1.1 Percutaneous Drainage 75.3.2 Surgical Treatment 75.3.3 Prognosis References 76: Large Bowel Obstruction 76.1 Introduction 76.2 Diagnosis 76.3 Management References Further Reading 77: Large Bowel Perforation 77.1 Introduction 77.1.1 Epidemiology 77.1.2 Etiology 77.1.3 Classification (Table 77.1) 77.2 Diagnosis 77.2.1 Clinical Presentation 77.2.2 Tests 77.3 Treatment 77.3.1 Medical Treatment 77.3.2 Surgical Treatment 77.3.2.1 Non-traumatic Perforations Colorectal Cancer Ischemic Colitis Ulcerative Colitis 77.3.2.2 Stercoral Perforations 77.3.2.3 Traumatic Perforations References Further Reading 78: Emergency Management of Abdominal Wall Hernia 78.1 Introduction 78.1.1 The (Societal) Problem of Abdominal Wall Hernia 78.1.2 Classification 78.1.2.1 Incarcerated and Strangulated Hernias 78.1.3 Etiology and Hernia Risk Factors 78.2 Diagnosis 78.2.1 Clinical Presentation 78.2.2 Diagnostics 78.3 Treatment 78.3.1 Medical Treatment 78.3.2 Surgical Treatment 78.3.2.1 Timing and Access 78.3.2.2 Use of Mesh 78.3.2.3 Preoperative Preparation 78.3.3 Prognosis References Further Reading 79: Emergency Management of Internal Hernia 79.1 Introduction 79.2 Epidemiology 79.3 Etiology 79.4 Pathophysiology 79.5 Classification and Types 79.6 Diagnosis 79.6.1 Clinical Presentation 79.6.2 Diagnostic Studies 79.7 Treatment 79.7.1 Medical Treatment 79.7.2 Surgical Treatment 79.7.3 Prognosis References 80: Emergency Management Hiatal Hernia and Gastric Volvulus 80.1 Introduction 80.2 Paraesophageal Hernia 80.2.1 Classification 80.2.2 Clinical Presentation and Diagnosis 80.3 Gastric Volvulus 80.3.1 Etiology 80.3.2 Classification 80.3.3 Clinical Picture 80.4 Treatment 80.4.1 Preoperative Management 80.4.2 Endoscopic Therapy 80.4.3 Anterior Abdominal Wall Gastropexy 80.4.4 Laparoscopy Gastropexy 80.4.5 Laparoscopic Sutured Gastropexy 80.5 Surgery for Gastric Volvulus with Paraesophageal Hernia 80.5.1 Open Surgery 80.5.2 Laparoscopy Surgery 80.5.3 Postoperative Management 80.6 Conclusion References Further Reading 81: Stoma-Related Surgical Emergencies 81.1 Introduction 81.2 Diagnosis and Treatment 81.3 Early Complications Needing for Emergency Surgery 81.3.1 Evisceration 81.3.2 Ischemia and Stoma Necrosis 81.3.3 Bleeding 81.3.4 Stoma Retraction 81.3.5 Parastomal Infection 81.3.6 Mucocutaneous Separation 81.3.7 Early Obstruction 81.4 Late Complications Requiring Emergency Surgery 81.4.1 Parastomal Hernias 81.4.2 Stoma Prolapse 81.4.3 Stoma Stenosis 81.4.4 Stoma Fistula 81.4.5 Intestinal Obstruction in the Late Period 81.5 Conclusion References 82: Inflammatory Bowel Disease 82.1 Introduction 82.2 Diagnosis 82.2.1 Clinical Presentation 82.2.2 Diagnostic Management 82.3 Treatment 82.3.1 Medical Treatment 82.3.2 Indications for Emergency Surgery 82.3.2.1 Acute Severe Colitis 82.3.2.2 Toxic Megacolon 82.3.2.3 Bowel Obstruction 82.3.2.4 Gastrointestinal Hemorrhage 82.3.2.5 Penetrating Crohn’s Disease Perianal Disease Intra-abdominal Fistula, Abscess, and Perforation Enterocutaneous Fistula 82.3.2.6 Appendicitis in Patients with Inflammatory Bowel Disease 82.3.3 Basic Principles of Emergency Surgery for Inflammatory Bowel Disease 82.3.3.1 Principles of Emergency Surgery for Crohn’s Disease 82.3.3.2 Principles of Emergency Surgery for Ulcerative Colitis 82.3.3.3 Prevention of Venous Thromboembolism 82.3.3.4 Risk of Colorectal Cancer References Further Reading 83: Fulminant/Toxic Colitis 83.1 Introduction 83.1.1 Epidemiology 83.1.2 Etiology 83.1.3 Classification 83.1.4 Pathophysiology 83.2 Diagnosis 83.2.1 Clinical Presentation 83.2.2 Tests 83.2.2.1 Laboratory Investigations 83.2.2.2 Imaging 83.2.2.3 Endoscopy 83.3 Treatment 83.3.1 Medical Treatment 83.3.2 Surgical Treatment 83.3.3 Prognosis References Further Reading 84: Clostridium Infections 84.1 Introduction 84.1.1 Healthcare-Associated CDI (HCA-CDI) 84.1.2 Community-Associated (CA-) CDI 84.1.3 Indeterminate and Unknown CDI 84.1.4 Pediatric Setting 84.2 Epidemiology 84.3 027 Ribotype 84.4 Risk Factors 84.4.1 Host Predisposing Factors 84.4.2 Exposure to Spores 84.4.3 Colonic Microbiome Disruption 84.4.4 Antibiotic Exposure 84.4.5 Other Medications 84.4.6 Surgery 84.4.7 Risk Factors for CA-CDI 84.5 Clinical Features 84.5.1 Asymptomatic Patients 84.5.2 Mild-to-Moderate CDI 84.5.3 Severe CDI 84.5.4 Fulminant CDI 84.5.5 Toxic Megacolon 84.5.6 Cure 84.6 Mechanism of Action 84.7 Toxins 84.8 Recurrences 84.9 Diagnosis 84.9.1 Glutamate Dehydrogenase (GDH) 84.9.2 Toxins 84.9.3 Nucleic Acid Amplification Tests (NAATs) 84.9.4 Culture 84.9.5 Best Diagnostic Method: Algorithm 84.9.6 Other Diagnostic Methods 84.9.7 Radiological Diagnostic Imaging 84.9.8 Endoscopy 84.9.9 Laboratory Tests 84.9.10 Diagnosis in Pediatric Setting 84.10 Antibiotic Therapy 84.10.1 Metronidazole 84.10.2 Vancomycin 84.10.3 Fidaxomicin 84.10.4 Treatment 84.10.5 Other Options 84.10.6 Newer Antibiotics 84.10.7 Treatment of Recurrences 84.11 Monoclonal Antibodies 84.12 Fecal Transplantation 84.13 Other Possible Therapies 84.13.1 Supportive Care 84.13.2 Probiotics 84.13.3 Intravenous Immunoglobulin 84.13.4 Antimotility Agents 84.14 Surgical Management 84.15 Stewardship and Infection Control 84.15.1 Antibiotic Stewardship 84.15.2 Contact Precautions 84.15.3 Hand Hygiene and Barrier Precautions (Gloves and Gowns) 84.15.4 Environmental Cleaning 84.15.5 Screening of Asymptomatic Patients 84.15.6 Open Issues References 85: Bowel Parasitic Surgical Emergencies 85.1 Introduction 85.1.1 Epidemiology 85.1.2 Etiology 85.1.3 Physiopathology 85.2 Diagnosis 85.2.1 Clinical Presentation 85.2.2 Tests 85.2.2.1 Biology 85.2.2.2 Imaging 85.2.2.3 Endoscopy 85.2.3 Final Diagnosis 85.3 Treatment 85.3.1 Medical Treatment 85.3.1.1 Drugs 85.3.1.2 Endoscopy 85.3.2 Surgical Treatment 85.3.2.1 Principles 85.3.2.2 Indications 85.3.3 Prognosis References Further Reading 86: Anorectal Emergencies 86.1 Introduction 86.1.1 Classification 86.2 Anorectal Abscess 86.2.1 Epidemiology 86.2.2 Etiology 86.2.3 Pathophysiology 86.2.4 Diagnosis 86.2.4.1 Clinical Presentation 86.2.4.2 Tests 86.2.5 Treatment 86.2.5.1 Medical Treatment 86.2.5.2 Surgical Treatment 86.2.6 Prognosis 86.3 Perineal Necrotizing Fasciitis (Fournier’s Gangrene) 86.3.1 Epidemiology 86.3.2 Etiology 86.3.3 Pathophysiology 86.3.4 Diagnosis 86.3.4.1 Clinical Presentation 86.3.4.2 Tests 86.3.5 Treatment 86.3.5.1 Medical Treatment 86.3.5.2 Surgical Treatment 86.3.6 Prognosis 86.4 Complicated Hemorrhoid (Thrombosed, Strangulated, or Bleeding) 86.4.1 Epidemiology 86.4.2 Etiology 86.4.3 Pathophysiology 86.4.4 Diagnosis 86.4.4.1 Clinical Presentation 86.4.4.2 Tests 86.4.5 Treatment 86.4.5.1 Medical Treatment 86.4.5.2 Surgical Treatment 86.4.6 Prognosis 86.5 Bleeding Anorectal Varices 86.5.1 Epidemiology 86.5.2 Etiology 86.5.3 Pathophysiology 86.5.4 Diagnosis 86.5.4.1 Clinical Presentation 86.5.4.2 Tests 86.5.5 Treatment 86.5.5.1 Medical Treatment 86.5.5.2 Surgical Treatment 86.5.6 Prognosis 86.6 Complicated Rectal Prolapse (Irreducible or Strangulated) 86.6.1 Epidemiology 86.6.2 Etiology 86.6.3 Pathophysiology 86.6.4 Diagnosis 86.6.4.1 Clinical Presentation 86.6.4.2 Tests 86.6.5 Treatment 86.6.5.1 Medical Treatment 86.6.5.2 Surgical Treatment 86.6.6 Prognosis 86.7 Retained Anorectal Foreign Bodies 86.7.1 Epidemiology 86.7.2 Etiology 86.7.3 Pathophysiology 86.7.4 Diagnosis 86.7.4.1 Clinical Presentation 86.7.4.2 Tests 86.7.5 Treatment 86.7.5.1 Medical Treatment 86.7.5.2 Surgical Treatment 86.7.6 Prognosis 86.8 Acute Anal Fissure 86.8.1 Epidemiology 86.8.2 Etiology 86.8.3 Pathophysiology 86.8.4 Diagnosis 86.8.4.1 Clinical Presentation 86.8.4.2 Tests 86.8.5 Treatment 86.8.5.1 Medical Treatment 86.8.5.2 Surgical Treatment 86.8.6 Prognosis References Further Reading 87: Gynaecological Surgical Emergencies 87.1 Introduction 87.2 Ectopic Pregnancy 87.2.1 Introduction 87.2.2 Diagnosis 87.2.3 Management 87.3 Adnexal Torsion 87.3.1 Introduction 87.3.2 Diagnosis 87.3.3 Management 87.4 PID and Tubo-Ovarian Abscess 87.4.1 Introduction 87.4.2 Diagnosis 87.4.3 Management 87.5 Female Non-obstetric Genital Injuries 87.6 Unsafe Abortions References 88: Nontraumatic Urologic Emergencies 88.1 Introduction 88.2 Penile Emergencies (Table 88.1) 88.2.1 Priapism 88.2.2 Classification and Pathophysiology 88.2.3 Diagnosis 88.2.4 Treatment (Medical) 88.2.4.1 Ischemic (Low Flow) Priapism 88.2.4.2 Stuttering Priapism 88.2.4.3 Nonischemic (Arterial, High-Flow) Priapism 88.2.5 Prognosis 88.3 Penile Ring Entrapment 88.3.1 Paraphimosis 88.3.2 Prognosis 88.4 Nontraumatic Scrotal Emergencies 88.4.1 Testicular Torsion 88.4.1.1 Epidemiology 88.4.1.2 Etiology 88.4.1.3 Pathophysiology 88.4.2 Diagnosis 88.4.2.1 Clinical Presentation 88.4.2.2 Imaging 88.4.2.3 Treatment (Surgical) 88.4.2.4 Prognosis 88.5 Fournier Gangrene 88.5.1 Epidemiology 88.5.2 Etiology 88.5.3 Pathophysiology 88.5.4 Diagnosis and Clinical Presentation 88.5.5 Tests 88.5.6 Treatment 88.5.7 Prognosis 88.6 Obstructing Nephrolithiasis 88.6.1 Epidemiology 88.6.2 Etiology 88.6.3 Pathophysiology 88.6.4 Diagnosis 88.6.4.1 Clinical Presentation 88.6.4.2 Laboratory Tests 88.6.4.3 Medical Treatment 88.6.4.4 Surgical Treatment 88.6.5 Prognosis 88.7 Acute Urinary Retention (AUR) 88.7.1 Epidemiology 88.7.2 Etiology 88.7.3 Classification 88.7.4 Pathophysiology 88.7.5 Diagnosis and Clinical Presentation 88.7.6 Clinical Presentation 88.7.7 Tests 88.7.8 Treatment 88.7.8.1 Medical Treatment 88.7.8.2 Surgical Treatment 88.7.9 Prognosis References 89: Non-Obstetric Abdominal Surgical Emergencies in Pregnancy and Puerperium 89.1 Background 89.1.1 Epidemiology 89.1.2 Etiology 89.1.3 Pathophysiology 89.2 Diagnosis 89.2.1 Acute Appendicitis 89.2.1.1 Clinical Presentation 89.2.1.2 Tests 89.2.2 Acute Biliary Disease 89.2.2.1 Clinical Presentation 89.2.2.2 Tests 89.2.3 Acute Pancreatitis 89.2.3.1 Clinical Presentation 89.2.3.2 Tests 89.2.4 Symptomatic Abdominal Wall Hernias 89.2.4.1 Clinical Presentation 89.2.4.2 Tests 89.2.5 Intestinal Obstruction 89.2.5.1 Clinical Presentation Plain Abdominal X-Rays 89.2.5.2 Transabdominal Ultrasound 89.2.6 Maternal Abdominal Trauma 89.2.6.1 Blunt Abdominal Trauma 89.2.6.2 Penetrating Abdominal Trauma 89.2.6.3 Fetomaternal Hemorrhage 89.2.6.4 Amniotic Fluid Embolism 89.2.6.5 Laboratory Findings 89.2.6.6 Plain Abdominal X-Rays 89.2.6.7 Transabdominal Ultrasound 89.2.6.8 Abdominal CT 89.3 Treatment 89.3.1 Acute Appendicitis 89.3.1.1 Medical Treatment 89.3.1.2 Surgical Treatment 89.3.1.3 Prognosis 89.3.2 Acute Biliary Disease 89.3.2.1 Medical Treatment 89.3.2.2 Surgical Treatment 89.3.2.3 Prognosis 89.3.3 Acute Pancreatitis 89.3.3.1 Medical Treatment 89.3.3.2 Surgical Treatment 89.3.3.3 Prognosis 89.3.4 Symptomatic Abdominal Wall Hernia 89.3.4.1 Medical Treatment 89.3.4.2 Surgical Treatment 89.3.4.3 Prognosis 89.3.5 Intestinal Obstruction 89.3.5.1 Medical Treatment 89.3.5.2 Surgical Treatment 89.3.5.3 Prognosis 89.3.6 Maternal Abdominal Trauma 89.3.6.1 Prehospital Treatment 89.3.6.2 Observation 89.3.6.3 Interventional Radiology 89.3.7 Surgical Treatment Blunt Trauma 89.3.7.1 Surgical Treatment Penetrating Trauma 89.3.8 Obstetric Treatment 89.3.9 Prognosis Blunt Abdominal Trauma 89.3.9.1 Prognosis Penetrating Abdominal Trauma References 90: Enterovesical and Enterogenital Fistulae 90.1 Introduction 90.1.1 History and Classification 90.1.2 Aetiology 90.1.3 Epidemiology 90.1.4 Pathophysiology 90.1.4.1 Inflammatory 90.1.4.2 Malignant 90.1.4.3 Iatrogenic 90.1.4.4 Trauma 90.2 Diagnosis 90.2.1 Clinical Presentation 90.2.2 Tests 90.3 Treatment 90.3.1 Medical Treatment 90.3.2 Surgical Treatment 90.3.3 Prognosis References Further Reading 91: Enterocutaneous and Enteroatmospheric Fistulae 91.1 Introduction 91.1.1 Definitions 91.1.2 Epidemiology 91.1.3 Aetiology 91.1.3.1 Aetiology—Iatrogenic ECFs and EAFs 91.1.3.2 Aetiology—Spontaneous ECFs 91.1.4 Classification 91.2 Diagnosis 91.2.1 Clinical Presentation 91.2.1.1 History 91.2.1.2 Examination 91.2.2 Tests 91.2.2.1 Identifying Associated Abdominal Pathology 91.2.2.2 Defining the Anatomy of an ECF 91.2.2.3 Investigations for the Sequelae of ECF and EAF 91.2.2.4 Investigations to Plan Definitive Closure of ECFs and EAFs 91.3 Treatment 91.3.1 Principles of Treatment 91.3.2 Medical Treatment 91.3.2.1 Wound Management 91.3.2.2 Treating Sepsis 91.3.2.3 Measures to Reduce Fistula Output 91.3.2.4 Optimizing Nutritional Status 91.3.2.5 Fibrin Sealant and Glue Closure of the Fistula 91.3.2.6 Novel Methods in Wound Management and Surgical Control of ECFs and EAFs 91.3.3 Surgical Treatment References Further Reading 92: Complication of Bariatric Surgery 92.1 Introduction 92.1.1 Epidemiology 92.1.2 Etiology 92.1.2.1 Types of Bariatric Surgery 92.1.2.2 Sleeve Gastrectomy (SG) 92.1.2.3 Roux-En-Y Gastric Bypass (RYGB) 92.1.2.4 Omega Anastomosis Gastric Bypass/Mini Gastric Bypass (OAGB/MGB) 92.1.2.5 Adjustable Gastric Banding (AGB) 92.1.2.6 Other Bariatric Procedures 92.1.3 Classification 92.1.4 Pathophysiology 92.1.4.1 Nonsurgical Complications 92.1.4.2 Surgical Complications Bleeding General Sleeve Gastrectomy Roux-En-Y Gastric Bypass and Omega Anastomosis Gastric Bypass/Mini Gastric Bypass Obstruction General Sleeve Gastrectomy Roux-En-Y Gastric Bypass Omega Anastomosis Gastric Bypass/Mini Gastric Bypass Adjustable Gastric Banding Systemic Inflammatory Response Syndrome (SIRS)/Sepsis Roux-En-Y Gastric Bypass and Omega Anastomosis Gastric Bypass/Mini Gastric Bypass Adjustable Gastric Banding Abdominal Pain/Discomfort 92.2 Diagnosis 92.2.1 Clinical Presentation 92.2.1.1 Airway 92.2.1.2 Breathing 92.2.1.3 Circulation 92.2.1.4 History 92.2.1.5 Physical Examination 92.2.2 Tests 92.2.2.1 Laboratory Tests 92.2.2.2 Imaging Studies X-Ray Upper Gastrointestinal Contrast Swallow Test 92.2.2.3 Computed Tomography (CT) 92.2.2.4 Endoscopy 92.2.2.5 Ultrasound (US) 92.3 Treatment 92.3.1 Medical Treatment 92.3.1.1 Bleeding 92.3.1.2 Obstruction 92.3.1.3 Systemic Inflammatory Response Syndrome (SIRS)/Sepsis 92.3.2 Surgical Treatment 92.3.3 Prognosis References Further Reading 93: Intra-Abdominal Hypertension and Abdominal Compartment Syndrome 93.1 Introduction 93.1.1 History of IAH and ACS 93.1.2 Normal IAP 93.1.3 IAH and ACS 93.1.4 Epidemiology 93.1.5 Pathophysiology 93.1.6 Systemic Effects of IAH/ACS 93.1.7 Neurological 93.1.8 Cardiovascular 93.1.9 Respiratory 93.1.10 Renal 93.1.11 Gastrointestinal 93.2 Diagnosis 93.2.1 When Should IAP Be Measured? 93.2.2 How Should IAP Be Measured? 93.2.3 Clinical Signs 93.3 Treatment 93.3.1 Medical Management 93.3.2 Interventional Management 93.3.3 Surgical Management 93.3.4 Prevention of IAH/ACS 93.3.5 Surgical Decompression 93.3.6 TAC 93.3.7 Wound Management and Complications 93.3.8 Abdominal Reconstruction 93.3.9 Prognosis 93.4 Conclusions References 94: Open Abdomen Management 94.1 Introduction 94.2 Aetiology 94.2.1 Traumatic Intra-Abdominal Bleeding 94.2.2 Intra-Abdominal Sepsis 94.2.3 Indications for OA: Trauma 94.2.4 Indications for OA: Non-Trauma 94.3 Diagnosis 94.4 Treatment 94.4.1 Temporary Abdominal Closure Techniques 94.4.2 Complications 94.4.2.1 Enteroatmospheric Fistula 94.4.2.2 Delayed Fascial Closure 94.4.2.3 Incisional Ventral Hernias References Further Reading 95: Liver Trauma 95.1 Introduction 95.1.1 Epidemiology 95.1.2 Etiology: Mechanism of Injury 95.2 Classification 95.3 Diagnosis of Liver Trauma 95.4 Management Strategies 95.5 Non-Operative Management (NOM) of Liver Injury 95.5.1 NOM in Penetrating Trauma 95.5.2 Concomitant Neurotrauma 95.5.3 Role of Laparoscopy 95.6 Operative Management (OM) 95.6.1 Specific Considerations 95.7 Complications 95.8 Thrombo-Prophylaxis, Feeding, and Mobilization 95.9 Follow-Up References Further Reading 96: Splenic Trauma 96.1 Introduction 96.2 Epidemiology 96.3 Etiology 96.4 Classification 96.5 Diagnosis 96.5.1 Clinical Presentation 96.5.2 Diagnostic Imaging 96.6 Management 96.6.1 Nonoperative Management (NOM) for Blunt Splenic Trauma 96.6.2 Nonoperative Management (NOM) for Penetrating Trauma 96.6.3 Role of Angiography and Angioembolization [AG/AE] in NOM 96.6.4 Operative Management (OM) 96.6.5 Thromboprophylaxis in Splenic Trauma 96.7 Prognosis: Short- and Long-Term Follow-up for NOM 96.8 Pediatric Splenic Trauma (