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Hugh Dudley) Who Should Look After the “Acute Abdomen” and Where? Everybody’s business is nobody’s business The majority of patients suspected of having an acute abdomen or other abdominal emergency do not require an operation. Nevertheless, it is you – the surgeon – who should take, or be granted, the leadership in assessing, excluding or treating this condition, or at least, play a major role in leading the managing team. To emphasize how crucial this issue is, we dedicate an entire section of this chapter to it – although its scope would fit into a paragraph.

31). The management of acute cholecystitis varies among surgeons. While past experience taught us that most of these patients would respond to antibiotics, “modern” surgeons prefer to operate early on a “hot” gallbladder – usually the next morning or whenever operating room schedule permits (> Chap. 19). Intestinal Obstruction The clinical pattern of intestinal obstruction consists of central, colicky abdominal pain, distension, constipation and vomiting. As a general rule the earlier and more pronounced the vomiting, the more proximal the site of obstruction is likely to be; the more marked the distension, the more distal the site of obstruction.

Do not abandon your ship while the storm rages on! Continuity of care is a sine qua non in the optimal care of the acute abdomen as the clinical picture, which may change rapidly, is a major determinant in the choice of therapy and its timing. Such patients need to be frequently re-assessed by the same clinician who should be a surgeon. Any deviation from this may be hazardous to the patient; this is our personal experience and that which is repeated ad nauseum in the literature. But why should we be re-inventing the wheel?