Schein's Common Sense Emergency Abdominal Surgery PDF
Preview Schein's Common Sense Emergency Abdominal Surgery
Moshe Schein · Paul N.Rogers (Editors) Schein’s Common Sense Emergency Abdominal Surgery Moshe Schein • Paul N. Rogers (Editors) Schein’s Common Sense Emergency Abdominal Surgery Second Edition With 97 Figures and 21 Tables MoshMe Socshheei nS,cMheDin,,FMACDS,,FFACCSS(,SFAC)S(SA) SurgicSaulr Sgpiceacli aSlpisetcsi aolfisKtse ookfuKke,oKkeuokk,uKke,oIkAu 5k2,6IA32 5,2U6S3A2,USA FormeFrolrym:Perrolyfe:sPsroorf eosfsSour rogfeSruy,rWgeeriyll, WCoelillel gCeo ollfeMgee odficMineedicine CorneCllo Urnneivlle Ursnitivy,eNrseitwy ,YNoerkw, YNoYr,kU,NSAY,USA Paul NP.aRuol gNe.rRs,oMgeBr sC,MhBB, MChBBA,,MMBDA,,FMRCDS, F(RGClaSs g(Gowla)sgow) ConsuCltoannstu Glteannet rGael nanerda Vl aanscdu Vlaars cSuulragre Sounr,gDeeopna,rDtmepeanrtt mofeSnut rogfeSruy rgery GartnGavaerlt nGaevneel rGael nHeorsapl iHtaol,sGpiltaaslg,Gowla,sSgcoowtl,aSncdo,tUlaKnd,UK EditorEidali tAordivails Aerd:vRiosebre:rRt oLbaenret, LMaDne,,FMRCDS,AFR,FCASCAS,FACS GraphGicrsa:pEhvigcse:nEyv Eg.e(nPye Ery.a(P) ePreyrae)l yPgeirne,lMygDin a,nMdD A alenxda Andleexra Nnd.Oerp Nar.iOn,pMarDin,MD LibraryL oibfrCaroyn ogrfeCsso nCgornetsrso Cllo Nnutrmolbl eNr:u2m0b04er1:024070046104706 ISBN I3S-B5N40 3-2-514503-62-105 3S6p-r0i n Sgperr iBngerelri nB eHreliind eHlbeeidrge lNbeerwg YNoerwk York ISBN 3-I5S4B0N-6 36-655440--06 6 16s5t4 e-d0. 1Ssptr eindg.eSrp-Vrienrglaegr- BVeerrlliang HBeeirdlienlb Heergid Nelebwe rYgo Nrkew York This wTorhkis isw osurkb jeisc ts utob jceocpt ytori gchotp.yArlilg hritg.hAtlsl arirgeh rtes saerrev erde,sewrhveetdh,ewr htehteh ewrh tohlee worh oplaer to ro fptahret of the materiaml aiste croianl ciesr ncoendc,esrpneecdif,icsaplelyc iftihcea lrlyig thhtes orifgthrtasn oslfattrioann,slraetpiornin,trienpgr,irnetuinseg ,orfeuilslue sotrfaitlilounstsr,ations, recitatiroenc,itbartoioand,cbarsotiandgc,arsetpinrogd,urecptiroond uocnt imoni coronf imlmic roorf iilnm a onry iont haenry woathy,ear nwda syt,oarnadg es tionr adgaeta in data banks.bDaunpklsic.aDtuiopnli ocafttihoins opfutbhliics aptuiobnli ocart pioanrt os rt hpearretos fthise preeorfmisit pteedr monitltye udn odnelry tuhned perro tvhies iporno ovfision of the Gertmhea Gn eCrompaynr iCghotp Lyariwg hotf LSaewpt oemfSbeeprt e9m,1b9e6r5 ,9i,n1 9it6s5 c,uinr rietsn tc uverrresinotn v,earnsdio pne,ramndis psieornm fiosrs iuosne for use must amlwuasyts ablwe aoybst abien eodb tfaroinmed S pfrroimng eSrp-rVienrglearg-.VVeirolalagt.ioVnios laatrieo nlias balree tloia pbrloe steoc uptrioosne cuuntdioenr tuhneder the GermaGn eCrompaynr iCghotp Lyraiwg.ht Law. SpringeSrp risi nag pera rits oaf pSaprrti nofgeSrp rSicniegnerc eS+cBieunscien+esBsu Msinedesias Media springesrporninligneer.oconmline.com © Sprin©g eSrp-rVienrglearg- VBeerrllaing HBeerildinel bHeerigd e2l0b0e0r,g2 2000050,2005 PrintedP irnin Gteedr mina Gnyermany The useT ohfe duessei gonfadteiosingsn,atrtiaodnesm,tarrakdse,metacr.kins ,tehtics. pinu tbhliicsa ptuiobnli dcaoteios nn odto iems pnloyt, eimvepnl yin,e tvheen a ibns tehnec aebsence of a spoefciafi cs psetcaitfeimc esntatt,etmhaetn ts,utchha tn saumcehs naarme eesx eamrep te xferommp t thfreo mre lethvea nrte lpervoatnetc tpivreo tleacwtisv ea nladws and regulatrieognus laantido nths earnedfo trhee frreefeo rfeo rf rgeeen feorra lg eunsee.ral use. ProducPt rloiadbuicltit yli:abTihliet yp:uTbhlies hpeurb cliasnh enr octa gnu naroatn gteuea rtahnet eaec ctuhrea cayc coufraacnyy oifnfaonrym iantfioornm aabtoiount about dosaged aonsdag aep apnlidc aatpiopnli ccaotniotani nceodn tiani nthedis ibno tohkis. Ibno eovke.rIyn ienvdeirvyid iunadli vciadsue atlh cea uses etrh em uusset rc mheucskt check such insfuocrhm iantfioornm bayt icoonn sbuyl tcionngs tuhleti nregl etvhaen rte llietvearanttu lritee.rature. Editor:EGdaitborri:elGea Sbcrhieröled Secr,hHröedideer,lbHeerigd,eGlbeerrmga,Gnyermany Desk edDietoskr: eSdteitpohra:nStieep Bheannkioe ,BHeenikdoe,lbHeerigd,eGlbeerrmga,Gnyermany ProducPtiroond uecdtiitoonr: eIdnigtorird: IHnagarsid,H Heaidase,lbHeerigd,eGlbeerrmga,Gnyermany Cover-DCoesviegrn-D:Fersiidgon :SFteriidnoen S-tBerinoeon,P-Baruo,oS,pPaainu,Spain TypeseTttyinpges:eFtotitnogsa:tFzo-Stoesravtizc-eS Kerövhicleer KGömhlbeHr ,GWmübrHzb,uWrüg,rzGbeurrmga,Gnyermany PrintinPgr ainntdin bgo aonkdb ibnodoinkgb:inSdtrianugs:sS-tOraffussest-dOruffcske tGdrmubcHk ,GMmöbrHle,nMbaöcrhle,nGbearcmha,Gnyermany PrintedP orinn taecdid o-nfr eaec ipda-fpreere. pape2r4./31502 4ih/3 -1 550 4 i h3 2- 51 40 3 2 1 0 Dedication MS dedicates this book to his late father Karl Schein (1911–1974), a surgeon on the Eastern Front during World War II,and later in Haifa,Israel. Editors’Note This book has been assembled – in pieces – during 20 years of intensive personal involvement,clinical and academic,with emergency abdominal surgery in South Africa,Israel,USA,UK and Australia. A long line of good old friends from all around the world were helpful in generating this book and its first edition.For the foundations in this noble surgical field MS is indebted to George G.Decker of Johannesburg.Drs.Roger Saadia, Asher Hirshberg and Adam Klipfel contributed to the first edition.Dr.Alfredo Sepulveda ofSantiago,Chile,provided aphorisms and edited the Spanish transla- tion.Professor Boris Savhcuk ofMoscow who edited the Russian translation passed away recently.We will remember him with affection. Special thanks to Frau Gabriele Schroeder and Frau Stephanie Benko of Springer-Verlag,Heidelberg,for their immense support.Most ofthe aphorisms and quotations used to decorate this book were retrieved from Aphorisms & Quotations for the Surgeon,edited by MS and published by Nikki Bramhill’s tfm Publishing Ltd, Harley,UK. The reader will find that there are not a few duplications scattered along the book.We did this on purpose,as repetition ofimportant points is crucial in adult education.Any reader who has a question or a comment about anything mentio- nedin this book is invited to e-mail us directly – [email protected] or [email protected] will respond. Finally,we are indebted to our loving wives,Heidiand Jackieand our children Omri,Yariv,Dan,Lucyand Michaelfor their patience and sacrifice. July 2004 Moshe Schein,New York Paul N.Rogers,Glasgow Preface to the Second Edition “In literature,as in love,we are astonished at what is chosen by others.” (Andre Maurois,1885–1967). In the harsh environment of the competitive publishing market only a tiny fraction ofmedical texts ever gets to see the light ofa second edition.Thus,we were proud to hear from our publishers that the first editionofthis book has been sold out.“Do you want us to simply re-printthe book”,they asked,“or do you think that it deserves to be updated andre-written?”We opted for the latter. Is there anything new in emergency abdominal surgery that merits the revision ofa 4-year-old book? Yes.Our practice has been gradually changing for the better and worse.Where we practice – in the “developed world”– the volume and spectrum of emergency surgery are declining and becoming narrower.Where any abdominal grumble is followed by a CT scan or any fart by a colonoscopy, ruptured aortic aneurysm and acute malignant colonic obstruction are becoming rarities.When most asymptomatic inguinal hernias undergo elective repair,one does not see many strangulated or obstructed groin hernias.When the entire population is being fed – or buys at the counter – anti-ulcer medications,operations for bleeding or perforated ulcer are hardly ever performed.This,however,may not be true in other parts ofthe world where you have the fortune (or misfortune) to practice. The way we practice emergency surgery has also been rapidly evolving. With almost unlimited access to abdominal imaging,we can rapidly pinpoint the diagnosis and avoid an unnecessary operation,or perform an indicated operation instead ofengaging in a prolonged period ofuncertainty.We are gradually becom- ing more selective and cautious – understanding that everything we do involves wielding a double-edged sword,and that in emergency surgery usually doing less is better but occasionally doing more may be life saving.Meanwhile fancy diagnostic modalities are used chaotically by our non-surgical colleagues (and some of our surgical ones) – producing red herringsor new “image diseases”,“incidentalomas” and adding to the general confusion. X Preface to the Second Edition This brave new world of changes needed to be incorporated into this book. We have to learn how to deal with the old s**t – which is perhaps becoming rarer – even when its odor is masked by the perfume ofmodern practice.And this is what we have attempted in this new edition – to recite the old basics but also show how to apply them in the evolving modern world. What is new in the Second Edition?We have a new co-editor.We added new chapters (viz., historical perspectives, imaging, esophageal and diaphragmatic emergencies,complications of endoscopy,pediatric emergencies,HIV patients, before the flight,before landing,and postoperative bleeding) by new contributors. All existing chapters have been revised or re-written by the old or new contributors and/or the Editors. We knew that a book like this – written in colloquial and “direct”style will be either loved or hated.And indeed,a few reviewers – appalled by dogmas that clash with their own – almost killed it .But many loved it;for example: From Germany:“Despite the “Wild West style”the book is far from being anachronistic.Instead,it is throughout updated and modern.To the experi- enced surgeons this book could provide joy with its wisdom and humor… What makes this book really very readable for the surgeons are the “pregnant” citations,aphorisms and “smart sayings”,which are often heard at the bed- side and operating rooms but almost never reach the pages of a book”. (P.Klein,Heidelberg,Chirurg,2000). From Scotland:“A surgeon of considerable experience may feel that they have little to learn from such a book,but this is written with short punchy chapters making it a very difficult book to put down…the wealth ofcommon sense in the book still makes it a worthwhile read and stimulates one’s own bias and views and challenges one’s own practice ofsurgery”.(R.A.B.Wood, Journal Royal College ofSurgeons ofEdinburgh,2000) From Sweden:“Through its direct language,the book becomes not only an entertaining lecture but also a valuable aid ofhandling patients with the acute abdomen.”(Svante Nordgren,Östra Sjukhuset,2000). From Russia:“Since Henry Mondor’s times in the forties ofthe last century there was no other book in clinical surgery to be written so easy and witty about most important things in the emergency abdominal surgery”.(Boris D. Savchuk,World Journal ofSurgery,2002). And from the many letters we received: A terrifically refreshing book,full of wisdom as well as wit.(Mr.George Youngson,Consultant Surgeon Aberdeen,Scotland) This is a very fantastic book and I have found a lot ofnew and useful advices in it (Dr.Csaba Csonka,Head Surgeon,Ajka,Hungary) Preface to the Second Edition XI Absolutely wonderful.I am going to make it compulsory reading for all ofmy registrars.Otherwise – fantastic!! (Eddie Chaloner,UK) I can’t remember a surgical book which I was able to digest with so much interest and without becoming tired even late at night. (Dr.med. Achim Schröder,Germany) This is one of the most useful and interesting surgical books in my library. You will read it in two hours with pleasure and interest and remember forever. (Dr.Andrea Favara,Milan,Italy) A book like this is long overdue.(Mr.R.D.Quill.Dublin,Ireland) A gold mine for the trainee surgical doctor.(Mr.Saboor Kahn,Wales,UK) By popular demand the First Edition of this book has been translated into Spanish and Russian. Motivated by the enthusiasm with which the book has been received across the world – particularly among those practicing “real surgery”in the “real world”– we set about enhancing it to produce a text that should be palatable to all of you – wherever you try to save lives – be it in Bogota,Dundee,Teheran,Calcutta, Naples,Dusseldorf,Krakov,Moscow or Boston.Ifyou are a surgeon who practices the way he was trained 20 or 30 years ago you will hate this book;ifyou are being trained by such a surgeon then you desperately need to read this book. Anton Chekhov said:“Doctors are just the same as lawyers;the only difference is that lawyers merely rob you,whereas doctors rob you and kill you,too.”Our chief aim in writing this book was to help you not to kill your patients.We hope that this modest book will be ofsome value to you. New York/Glasgow,July 2004 The Editors (> see figure) The Editors:Rogers is the one in the kilt… Contents I Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 1 General Philosophy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Moshe Schein · Paul N.Rogers 2 A BriefHistory ofEmergency Abdominal Surgery . . . . . . . . . . . . . . . . . 9 Harold Ellis II Before the Operation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 3 The Acute Abdomen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 Moshe Schein 4 Rational Diagnostic Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 Moshe Schein 5 Abdominal Imaging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 Moshe Schein · Sai Sajja · Hans Ulrich Elben 6 Optimizing the Patient . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55 James C.Rucinski 7 Pre-operative Antibiotics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67 Moshe Schein 8 Family,Ethics,Informed Consent and Medicolegal Issues . . . . . . . . . . . 71 James C.Rucinski 9 Before the Flight:Pre-op Checklist . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77 Moshe Schein
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