RT Book, Section
A1 Meehan, John
A2 Bishop, Warren P.
SR Print(0)
ID 55942781
T1 Chapter 21. Surgical Emergencies
T2 Pediatric Practice: Gastroenterology
YR 2010
FD 2010
PB The McGraw-Hill Companies
PP New York, NY
SN 978-0-07-163379-6
LK accesspediatrics.mhmedical.com/content.aspx?aid=55942781
RD 2024/04/24
AB The  term  “emergency”  is  subjective  and  therefore  can  be  difficult  to  define,  especially  when  considering  all  the  complexities  of  caring  for  a  sick  child  with  a  surgical  problem.  To  the  anxious  parent,  anything  surgical  may  be  an  emergency.  Healthcare  providers  often  have  differing  perspectives  on  what  is  or  is  not  an  emergency.  The  topics  in  this  chapter  are  all  surgical  issues  that  need  intervention,  most  in  a  relatively  short  period  of  time.  But  some  might  be  considered  “urgencies”  rather  than  true  surgical  emergencies.  For  example,  most  surgeons  do  not  consider  appendicitis  and  pyloric  stenosis  as  true  surgical  emergencies.  The  infant  with  pyloric  stenosis  is  often  delayed  hours,  possibly  even  days,  while  undergoing  the  necessary  fluid  rehydration  and  resuscitation.  Likewise,  appendicitis  can  be  temporized  with  IV  antibiotics  overnight  and  taken  to  the  operating  room  the  following  morning.  Conversely,  malrotation  with  midgut  volvulus  and  other  causes  of  ischemic  bowel  are  always  surgical  emergencies  due  to  the  impending  irreversible  effects  of  ongoing  ischemia.  Finally,  there  are  many  diagnoses  that  may  fall  over  a  wide  spectrum  of  severity.  Therefore,  the  clinical  picture  will  often  dictate  the  presence  of  an  emergency  more  than  the  diagnosis.  Many  congenital  and  acquired  pediatric  surgical  issues  can  progress  to  emergencies  if  the  underlying  problem  has  been  present  long  enough.  In  a  general  sense,  intervention  for  surgical  emergencies  and  the  less  acute  surgical  urgencies  fall  into  four  categories:  obstruction,  ischemia,  perforation,  and  bleeding.