Surgical site

Question 1

Post op complication examples

Answer 1

Infarcted bowel –> ischaemia, anastomotic breakdown, abscess, fistula

Ruptured AAA –> reactive or secondary haermorrhage/abdominal compartment syndrome/lower limb ischaemia/postoperative ileus
Endovascular repair: stent thrombosis, limb ischaemia, renal impairment, abdominal compartment syndrome

Diverticular abscess - anastomotic leak and recurrent sepsis, intraperitoneal abscess
Inotropic support –> risk of anastomotic leak or end stoma infarction

Stabbing - abdominal compartment syndrome

Appendicitis - wound infection, collection, abscess

Question 2

Intra abdominal pressure

Answer 2

10-15
Slight intestinal and hepatic ischaemia

16-25
Reduced preload and increased after load
Reduced CO
Oliguria
Marked intestinal and hepatic ischaemia

>25
Reduced contractility
Gross reduction in cardiac output
Anuria
Bowel infarction
Hepatic failure 
Increased ICP

Compartment syndrome is progression of pressure induced end-organ changes and, if due to intra-abdominal causes such as trauma or acute pancreatitis –> rapid deterioration

Can close with Bogota bag

Question 3

Anastomotic leakage

Answer 3

Can present with low grade fever, prolonged ileum, failure to thrive

Risk factors
Tension, poor blood supply (particularly anterior resection), unrecognised mesenteric damage, poor suture technique

Obstruction, ischaemia or peritonitis

Shock, age, malnutrition, immunosuppression

Question 4

SNAPS

Answer 4

Sepsis - drainage, or defuncitoning the bowel
Nutrition -
Anatomy - delineate by imaging the site of the leak, CT with contrast
Procedure - aim for reparative
Skin care - Determine what is coming out of fistula and protect skin accordingly