Treatments
Most common emergencies

Abdominal pains do not always indicate a serious problem that requires an operation. Yet, differentiating harmless from serious abdominal pains is one of the main challenges of abdominal surgery.

Acute appendicitis

Typical symptoms

Acute appendicitis is the most common emergency in abdominal surgery.

Appendicitis typically occurs within a few days or hours. Often, abdominal pain is felt in the area of the navel. This can become more intense and shift to the right lower abdomen.

Fever, nausea, vomiting and diarrhoea can be side effects.

Diagnosis

Often, specific enquiry into the medical history and an examination are sufficient to lead to suspicion of appendicitis. The diagnosis can also be confirmed with an ultrasound of the abdominal region and measurement of the inflammation parameters in the blood.

Treatment

We recommend surgical removal in the case of appendicitis. Appendicitis can only be treated with antibiotics in exceptional cases. As a rule, the appendix is removed with small incisions via keyhole technology (laparoscopy). Depending on the severity of the inflammation, the patients recover from the operation within a few days.

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Gallbladder inflammation

Typical symptoms

Acute cholecystitis is the second most common emergency in abdominal surgery.

A gallbladder inflammation often becomes noticeable via ongoing pain in the right upper abdomen. Sometimes, recurring stabbing pains occur after eating or at night, over weeks or months. What is responsible for the pain is gallstones, which can not only cause an inflammation of the gallbladder, but also the pancreas or bile ducts. The latter can develop into a life threatening disease.

Diagnosis

A correct diagnosis can be made by enquiring into the medical history, physical examination, laboratory tests of blood values and an ultrasound of the abdominal region. In some cases further examinations are required, especially if there is an indication that the pancreas or bile ducts are also involved.

Treatment

We recommend the removal of the gallbladder if the problems are caused by gallstones, as soon as possible after the appearance of the complaint. The treatment of gallbladder inflammations with antibiotics, and then its removal weeks later should not be standard. In addition, an operation is the only way that the stones can also be removed, which could not only be the cause of gallbladder inflammations, but also pancreatic and bile duct inflammations.

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Inflammation of the large intestine

Typical symptoms

Another common abdominal surgery emergency is diverticulitis. This is an inflammatory disease of the large intestine, very often in the so-called sigma.

Pain occurs within a few days, typically in the left lower abdomen. This can be so severe, that even gentle pressure on the abdominal wall causes pain.

The Colon sigmoideum (part of the large intestine, so called Sigma) is located in the left lower abdomen. Here, faecal residues in protrusions in the intestinal wall (diverticula) can lead to inflammations (diverticulitis). The inflammations can present very differently. For most patients, it is a simple inflammation, but for other patients, abscesses (suppurative focuses), peritonitis or even bleeding can occur.

Diagnostik

Neben der Krankengeschichte, der körperlichen Untersuchung und Laborwerten ist häufig eine Computertomografie (Schichtröntgen) des Bauches notwendig, um das gesamte Ausmass der Erkrankung zu erfassen. Im Verlauf, nicht während der akuten Entzündung, wird auch häufig eine Dickdarmspiegelung notwendig.

Therapie

Obwohl die Divertikulitis ganz unterschiedliche Ausprägungen haben kann, versuchen wir die akute Phase mit Antibiotika einzudämmen. Es ist nicht immer sofort eine Operation notwendig, auch bei schwereren Verläufen. Wenn eine Operation notwendig wird, dann versuchen wir diese im «entzündungsfreien Intervall» durchzuführen, dann wenn es den Patienten am besten geht. So können sich die Patienten von der Operation deutlich schneller erholen und der Eingriff ist meistens in der sog. Schlüssellochtechnik möglich.

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