Advertisement

Perforations of the Upper Gastrointestinal Tract

  • Paolo BernanteEmail author
  • Matteo Rottoli
  • Stefano Cariani
  • Francesca Balsamo
  • Gilberto Poggioli
Chapter
Part of the Updates in Surgery book series (UPDATESSURG)

Abstract

It is becoming more common for surgeons to manage obese patients in the acute setting with non-bariatric surgical emergencies. Obesity presents a diagnostic challenge for the acute care surgeon. Given the emergent need for intervention and the subsequently minimized opportunity for preoperative selection and optimization, obese patients requiring emergency surgery represent a complex patient population at high risk for perioperative morbidity.

There is nothing unique about perforations of the upper gastrointestinal tract in the obese population versus other patients but there are specific additional considerations that the acute care surgeon should be aware of. It is particularly important that obese patients requiring emergency surgery are managed by an anesthetist experienced in the care of the obese along with an experienced surgeon in order to minimize the operative time and the risk of complications.

Bariatric surgical expertise seems to favorably impact hospital length of stay and the application of more minimally invasive approaches in cases not routinely done laparoscopically.

Keywords

Upper gastrointestinal perforations Acute care surgery Obesity Bariatric surgery Minimally invasive surgery 

References

  1. 1.
    Camilleri M, Malhi H, Acosta A. Gastrointestinal complications of obesity. Gastroenterology. 2017;152:1656–70.CrossRefGoogle Scholar
  2. 2.
    Flint R. Differences in acute general surgical admissions between obese or overweight patients compared to normal-sized patients. N Z Med J. 2015;128:35–41.PubMedGoogle Scholar
  3. 3.
    Pakula A, Skinner R. Do acute care surgeons need bariatric surgical training to ensure optimal outcomes in obese patients with nonbariatric emergencies? Surg Obes Relat Dis. 2018;14:339–41.CrossRefGoogle Scholar
  4. 4.
    Bernante P, Breda C, Zangrandi F, et al. Emergency sleeve gastrectomy as rescue treatment for acute gastric necrosis due to type II paraesophageal hernia in an obese woman with gastric banding. Obes Surg. 2008;18:737–41.CrossRefGoogle Scholar
  5. 5.
    ASGE Standards of Practice Committee, Ben-Menachem T, Decker GA, Early DS, et al. Adverse events of upper GI endoscopy. Gastrointest Endosc. 2012;76:707–18.CrossRefGoogle Scholar
  6. 6.
    Cotton PB, Garrow DA, Gallagher J, Romagnuolo J. Risk factors for complications after ERCP: a multivariate analysis of 11,497 procedures over 12 years. Gastrointest Endosc. 2009;70:80–8.CrossRefGoogle Scholar
  7. 7.
    Bigolin AV, Rinaldi N, Menguer R, et al. Case report: are we prepared to manage acute abdomen in the super-obese patient? J Obes Overweight. 2017;3:105.  https://doi.org/10.15744/2455-7633.3.105.CrossRefGoogle Scholar
  8. 8.
    Kupper S, Karvellas CJ, Khadaroo RG, Widder SL. Increased health services use by severely obese patients undergoing emergency surgery: a retrospective color study. Can J Surg. 2015;58:41–7.CrossRefGoogle Scholar
  9. 9.
    Brown CVR, Velmahos GC. The consequences of obesity on trauma, emergency surgery, and surgical critical care. World J Emerg Surg. 2006;1:27.  https://doi.org/10.1186/1749-7922-1-27.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Jung Y. Management of gastrointestinal tract perforations. Gastrointest Interv. 2017;6:157–61.CrossRefGoogle Scholar
  11. 11.
    Mennigen R, Senninger N, Laukoetter MG. Novel treatment options for perforations of the upper gastrointestinal tract: endoscopic vacuum therapy and over-the-scope clips. World J Gastroenterol. 2014;20:7767–76.CrossRefGoogle Scholar
  12. 12.
    Pournaras DJ, Hardwick RH, Safranek PM, et al. Endoluminal Vacuum Therapy (E-Vac): a treatment option in oesophagogastric surgery. World J Surg. 2018;42:2507–11.CrossRefGoogle Scholar
  13. 13.
    Negoi I, Beuran M, Ciubotaru C, et al. The laparoscopic approach in emergency surgery: a review of the literature. J Acute Dis. 2018;7:15–9.CrossRefGoogle Scholar
  14. 14.
    Byrne BE, Bassett M, Rogers CA, et al. Short-term outcomes after emergency surgery for complicated peptic ulcer disease from the UK National Emergency Laparotomy Audit: a cohort study. BMJ Open. 2018;8:e023721.  https://doi.org/10.1136/bmjopen-2018-023721.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Paolo Bernante
    • 1
    Email author
  • Matteo Rottoli
    • 1
  • Stefano Cariani
    • 1
  • Francesca Balsamo
    • 1
  • Gilberto Poggioli
    • 1
  1. 1.Department of Medical and Surgical SciencesUniversity of Bologna, S. Orsola-Malpighi University HospitalBolognaItaly

Personalised recommendations