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 2024/11/09 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.