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 MosheMoshe Schein, Schein, MD, FACS, MD, FACS, FCS(SA) FCS(SA) SurgicalSurgical Specialists Specialists of Keokuk, of Keokuk, Keokuk, Keokuk, IA 52632, IA 52632, USA USA FormerlyFormerly: Professor: Professor of Surgery,Weill of Surgery,Weill College College of Medicine of Medicine CornellCornell University, University, New York, New York, NY,USA NY,USA Paul N.Paul Rogers, N. Rogers, MB ChB, MB MBA,ChB, MBA, MD, FRCS MD, FRCS(Glasgow) (Glasgow) ConsultantConsultant General General and Vascular and Vascular Surgeon, Surgeon, Department Department of Surgery of Surgery GartnavelGartnavel General General Hospital, Hospital, Glasgow, Glasgow, Scotland, Scotland, UK UK EditorialEditorial Adviser: Adviser:RobertRobert Lane, Lane, MD, FRCSA, MD, FRCSA, FACS FACS Graphics:Graphics:EvgenyEvgeny E. (Perya) E. (Perya) Perelygin, Perelygin, MD and MD Alexander and Alexander N. Oparin, N. Oparin, MD MD LibraryLibrary of Congress of Congress Controll Controll Number: Number: 2004104706 2004104706 ISBN ISBN3-540-21536-0 3-540-21536-0 Springer Springer Berlin Berlin Heidelberg Heidelberg New YorkNew York ISBN 3-540-66654-0ISBN 3-540-66654-0 1st ed. 1st Springer-Verlag ed. Springer-Verlag Berlin HeidelbergBerlin Heidelberg New York New York This workThis iswork subject is subject to copyright. to copyright. All rights All arerights reserved, are reserved, whether whether the whole the wholeor part or of part the of the materialmaterial is concerned, is concerned, specifically specifically the rights the ofrights translation, of translation, reprinting, reprinting, reuse of reuse illustrations, of illustrations, recitation,recitation, broadcasting, broadcasting, reproduction reproduction on microfilm on microfilm or in any or inother any way,other and way, storage and storage in data in data banks.banks. Duplication Duplication of this ofpublication this publication or parts or thereof parts thereof is permitted is permitted only under only theunder provision the provision of of the Germanthe German Copyright Copyright Law of Law September of September 9, 1965, 9, in 1965, its current in its current version, version, and permission and permission for use for use must alwaysmust alwaysbe obtained be obtained from Springer-Verlag. from Springer-Verlag. Violations Violations are liable are toliable prosecution to prosecution under theunder the GermanGerman Copyright Copyright Law. Law. SpringerSpringer is a part is ofa part Springer of Springer Science+Business Science+Business Media Media springeronline.comspringeronline.com © Springer-Verlag© Springer-Verlag Berlin HeidelbergBerlin Heidelberg 2000, 2005 2000, 2005 PrintedPrinted in Germany in Germany The useThe of designations,use of designations, trademarks, trademarks, etc. in this etc. publication in this publication does not does imply, not evenimply, in even the absence in the absence of a specificof a specific statement, statement, that such that names such namesare exempt are exempt from thefrom relevant the relevant protective protective laws and laws and regulationsregulations and therefore and therefore free for free general for general use. use. ProductProduct liability: liability: The publisher The publisher can not can guarantee not guarantee the accuracy the accuracy of any ofinformation any information about about dosagedosage and application and application contained contained in this inbook. this Inbook. every In individualevery individual case the case user the must user check must check such informationsuch information by consulting by consulting the relevant the relevant literature. literature. Editor:Editor: Gabriele Gabriele Schröder, Schröder, Heidelberg, Heidelberg, Germany Germany Desk editor:Desk editor: Stephanie Stephanie Benko, Benko, Heidelberg, Heidelberg, Germany Germany ProductionProduction editor: editor: Ingrid IngridHaas, Heidelberg,Haas, Heidelberg, Germany Germany Cover-Design:Cover-Design: Frido Steinen-Broo, Frido Steinen-Broo, Pau, Spain Pau, Spain Typesetting:Typesetting: Fotosatz-Service Fotosatz-Service Köhler KöhlerGmbH, GmbH, Würzburg, Würzburg, Germany Germany PrintingPrinting and bookbinding: and bookbinding: Strauss-Offsetdruck Strauss-Offsetdruck GmbH, GmbH, Mörlenbach, Mörlenbach, Germany Germany PrintedPrinted on acid-free on acid-free paper. paper. 24/3150 24/3150 ih - 5 4 ih 3 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 of Santiago, Chile, provided aphorisms and edited the Spanish translation.Professor Boris Savhcuk of Moscow 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 of the 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 of important points is crucial in adult education. Any reader who has a question or a comment about anything mentio- ned in this book is invited to e-mail us directly – [email protected] or [email protected] will respond. Finally,we are indebted to our loving wives,Heidi and Jackie and our children Omri, Ya r iv, D a n , Lucy and Michael for 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 of medical texts ever gets to see the light of a second edition. Thus, we were proud to hear from our publishers that the first edition of this book has been sold out.“Do you want us to simply re-print the book”, they asked,“or do you think that it deserves to be updated and re-written?”We opted for the latter. Is there anything new in emergency abdominal surgery that merits the revision of a 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 of the 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 of engaging in a prolonged period of uncertainty.We are gradually becoming 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 herrings or 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 of modern 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

Load more