ACUT ABDOMEN

By
I B Darma Putra, M.D.
Digestive Surgeon (Cunsultant)
Surgery Department-Faculty of Medicine University of Udayana
Sanglah General Hospital
Denpasar - Bali

Acute Abdomen
Definition :
All emergency conditions in the abdomen which
appropriate and adequate managements are
mandatory.
Includes :
1. Infection
2. Ileus
3. Bleeding
4. Trauma

Ileus
Definition :
the abnormality of intestinal passage

There are 2 kinds :

1. Obstruction ileus
2. Paralytic ileus

Obstruction ileus
Symptom :
intestinal colicky pain (abdominal colicky pain)
Signs :
1. Darm contour
2. Darm steifung
3. Increase bowel sound (klinken/metalic sound)
4. Herring bone sign (on Plain Abd X-ray)

Etiology :
1.
2.
3.
4.
5.
6.
7.
8.

GIT malignant tumor

Incarcerate hernia
Invagination
Volvulus
Bowel adhesion
Congenital anomaly
Meconeum meconium plug syndrome
Ascariasis

Treatment :
1.
2.
3.
4.
5.
6.

Fluid and electrolites resuscitation

Nasogastric tube installation (decompression)
Indwelling urinary catheter
All necessary investigations (ECG)
Prophylactic antibiotic
Surgery (as causative as possible)

Paralytic ileus
Myriads of causes :
1. Sepsis
2. Uremia
3. Hypokalemia
4. Pneumonia
5. Nerve damage
6. etc

Treatment :
1.
2.
3.
4.
5.
6.

Recovering the fluid and electrolites balance (IV

drip)
Gastric decompression (NGT installation)
Correct the bowel supporting factors (eg.,
potassium, Hgb, Albumin)
Medications to stimulate bowel peristaltic
movement (eg., vit B1 and prostigmine)
Total bowel rest
The most important : eliminating causative
factors

Bleeding

What is mentioned here is bleeding from

intestinal lumen

Can be divided into 3 parts :

1. Upper intestinal bleeding
2. Middle intestinal bleeding
3. Lower intestinal bleeding

Upper intestinal bleeding

Symptoms : Haematemesis and Melena
Etiology :
1. Oesophageal varices
2. Peptic ulcer
3. Malignancy
4. etc
Diagnosis :
5. NGT installation-blood-washing
6. U.G.I. Photo
7. Endoscopy

Meddle intestinal bleeding

Symptom : Melena
Etiology :
1. Abdominal typhoid
2. Diverticelle
3. Hemangioma
4. etc
Diagnosis : difficult
Arteriography (bleeding>2 cc/min)

Lower intestinal bleeding

Symptom :
1. Fresh blood
2. Melena with blood clot
Etiology :
3. Hemorrhoids
4. Malignancy
5. Polip
6. Invagination
7. etc

Diagnosis :
1. Digital rectal examination
2. Proctoscopy
3. Rectoscopy
4. Sigmoidoscopy
5. Colonoscopy
6. Barium In loop
Management for Intestinal Bleeding
7. Conservative
8. Surgery

Conservative :
If to maintain Hgb level of >10 g% only
500 cc of blood is needed in 24 hours.
Surgery :
If conservative treament fails
Surgical mode depends on the causes

Incarcerate Hernia
The most common cause for obstruction ileus
Symptoms/initially
Reducible hernia irreducible
Felt pain on the mass
Abdominal pain - vomiting
Treatment : surgery as immediate as possible

Acute Invagination
Most often occurs in children/infant 4 mo 1 yo
Good nutritional state
E/ not clear yet
S/initial - abd pain (the kid often screaming)
- vomiting
- followed by fresh blood stool
as strawberry / currant jelly stool)

On examination
Obstruction signs
TRIAD
abdomen

Sausage mass in the

Fresh blood (+) on DRE

(digital rectal examination)

If the symptoms found before 24 hours

Barium In loop
Treatment
Resuscitation - laparotomy

Volvulus
Definition :
A condition where the bowel rotates on
mesenteric axis
There are 2 problems : severe ileus and
strangulation
The patient in severe pain and rapid progression
to worst contition
S/ often abrupt in onset accompany with severe
abdominal pain, vomiting, sometimes followed by
fresh blood stool

Examination :
May be there hasnt been any severe dehidration
signs yet, but often there is pre-shock condition
DRE often with blood (+)
Plain Abd X-ray asymetrical bowel pattern
Treatment emergent laparatomy

Abdominal cavity infection (Peritonitis)

Divided into :
1. Primary
2. Secondary
Other classifications :
3. Local
4. General

Primary Peritonitis : the cause is not known

Secondary Peritonitis : caused by leakage of the
intra-abdomen hollow organ
Local Peritonitis : the infection still
local/localized by body defense system.
Examples : Acute appendicitis and acute
cholecystitis