Teamwork radiology and surgery

Catchment area

Teamwork radiology and surgery

Jigsaw TRAUMA Cholecystitis Perforation Appendicitis OP X-ray Abdominal wall Endoscopy GI bleeding Diverticulitis Pancreatitis Ileus Complex and timeconsuming investigations

Be realistic but recognise the cangoroo Surgeons without guidelines

Concensus 2007 Smart surgeons learn from their own mistakes Smarter surgeons learn from mistakes of others Some never learn The CT makes it easier and improves quality

Guidelines Routines Guidelines Development

Surgeons with guidelines Jays ace Roy Halladay has appendicitis Toronto Blue Jays starting pitcher Roy Halladay throws during first inning AL action against the Boston Red Sox on Thursday, May 10, 2007, in Toronto, Canada

Appendicit Acute appendicitis can mimic virtually any intra-abdominal process: therefore to know acute appendicitis is to know well the diagnosis of acute abdominal pain. (Z.Cope) History 200 Aretaios 1492 da Vinci 1734 paratyflitis 1880 The first operation 1889 The first op in Sweden, Lennander 1983 The first lap-app-op in Sweden

Peritonitis Harry Hodini died from an appendicitis -26 Appendicitis Development of pain Location Local tenderness Developemnt of CRP and LPK Exclusion of alternate diagnoses Need to operate

Diagnostics Why? Avoid unnessecary operations Reduce the risk of missing important diagnoses Indicator of quality Earlier 25-30% healthy app Now 5-10% Appendicitis diagnostic tools

Assessment and reassessment Observation Repetivite assessments CRP-LPK CRP LPK Tid

Our golden-standard appendicitis Clinical diagnosis Ultrasound in children Diagnosis after CT in patients with unclear conditions. Laparoscopy in women And sometimes in men

Diverticulitis

Diverticulitis Mild to moderate Clinical diagnosis Confirmed later by imaging or colonoscopy Rule out malignancy Moderate to severe Clinical findings CT CT findings are prognostic Diverticulitis Mild to moderate Clinical diagnosis Confirmed later by imaging or colonoscopy Rule out malignancy Moderate to severe Clinical findings CT CT findings are prognostic Ambrosetti classification

Treatment Mild to moderate Fasting? Antibiotics? Moderate to severe Antibiotics Operation Resection Resection with peroperative lavage

Happy colorectal surgeons after the procedure Jejunumdivertikulis

Obstruction Colocolic invagination

Gallstone ileus Diffuse ischemia

Adhesive band Bowel ischemia

Strangulation Operation

Internal mesenteric hernia Emergency operation Surgeon on call operates an emergency case

Second look Surgeon on call reoperates an emergency case Postoperative complications Always suspect surgical reasons

Postoperative complications Always suspect surgical reasons (at least when other surgeons have operated) Postop complications Assess

Postop complications Assess Think Postop complications Assess Act Think

Postoperative complications Time-span Immediate Within days Within weeks-months Postoperative complications CPBF Cardiac Pulmonary Bleeding Fluid retention

Postoperative complications Peritonitis Anastomotic leakage Following perforated ulcer incopmlete raphi Deep infection Abscess Postoperative complications Abdominal wall Subcutaneous wound rupture Early incarceration Following laparoscopy Infection Mild Severe With flegmone Clostridie infection

Severe pain out of proportion Strangulation Gas gangraene Postoperative complications Bile ducts Bile leakage Bile duct obstruction

Postoperative complications Bariatric surgery Internal hernias Incarceration of bowels in troacar incisions Postoperative complications Bleeding Procedure Elective Emergency Due to bleeding

PEG and complications PEG complications Immediate complications Perforation of organs Bleeding Displacement Non-functioning Peritonitis Leakage

Abdominal compartment WSACS World Society of the Abdominal Compartment Syndrome Intensive care

Abdominal compartment Reasons Intraabdominal complications Reperfusion Ileus Post major intra- and retroperitoneal bleeding Severe pancreatitis Correlates to High BMI Extensive fluid resuscitation Abdominellt compartment How to measure the abdominal pressure KAD, 25 ml water into the bladder

Jejunumdivertikulit Ileus

Colocolisk invagination Tunntarmsinvagination Metastaserande lungcancer

Malrotation The bowel mesentery gets a broad attachment to the back abdominal wall Gör en nonrotation

Malrotation Mesenterica superior syndrom

Richter-bråck

Diffus tarmischemi Questions/discussion