COLLEGE OF MEDICINE AND HEALTH SCIENCE

DEPARTMENT OF MIDWIFERY
SEMINAR PRESENTATION ON
EMERGENCY SURGICAL PROCEDURES
BY Abeje & Firomisa
AUGEST 2023
HAWASSA , ETHIOPIA
Outline

Introduction

General preoperative preparation for emergency surgery

Situations that require emergency surgical procedures

Common emergency surgical procedures

Summery
Objectives

After the end of this seminar presentation the audience will be able to:

Understand preoperative preparation of surgery.

Differentiate cases that require emergency surgery.

Identify common emergency surgical procedures.

Know how different emergency surgical procedures were performed.

Introduction

Surgery is the procedure that involves cutting of a patient’s tissue or closer

of previously sustained wound.

Surgical procedure classified based on different circumstance.

Based on urgency it is divided into elective, urgent and emergency surgery.

Emergency surgery is a surgery that must be performed immediately before

a person might die or be permanently harmed.

Usually performed within 24 hours even during the night.

Cont…

ES undergo to treat trauma or acute illness subsequent to an emergency

presentation.

It includes unplanned surgery for admitted patients and unplanned surgery

for patients already awaiting an elective surgery procedure.

Eligible patients are those patients who have traumatic injuries, acute

illness, or deterioration in existing conditions.

General anesthesia is usually given during emergency surgeries.

Cont…

It involves resuscitation and stabilization of the patient, preparing for

surgery, and post-operative and recovery procedures.

Upon arriving at the emergency staff will begin to assess the person’s
condition like:
Taking vital signs
Performing a physical exam, and
Taking a history of the person's past and present illnesses, allergies, and
medication use.
General preoperative preparation
Patient evaluation
Medical history, current condition, and any relevant test results are
reviewed.
Informed consent

Explains the procedure, its risks and benefits, and any alternative options to
the patient; then written consent.

Anesthesia administration

The patient is prepared for anesthesia administration; inserting IV lines for

medications and fluids and monitoring devices to assess vital signs.
Cont…
Surgical site preparation

Using antiseptic solutions to reduce the risk of infection.

Hair in the area may be shaved or clipped if necessary.

Equipment and instrument setup

Instruments and equipment's are prepared and checked for proper
functioning.
Ensuring the availability of emergency equipment's.
Team briefing
Situations that require emergency surgical procedures

Trauma

Treat injuries resulting from accidents, falls, or violence.

Includes repairing fractures, stopping bleeding, removing foreign objects.

Acute abdominal conditions

Appendicitis, bowel obstruction, perforated ulcers etc.

Emergency surgery to alleviate pain, prevent further complications.

Obstetric emergencies to ensure the safety of the mother and baby.

Cont…
Infections
Severe infections like abscesses require emergency surgical drainage.
To prevent the spread of infection and preserve tissue viability.

Vascular emergencies
Ruptured aneurysms, arterial embolisms require emergency surgery.

To repair blood vessels, remove clots, or restore blood flow.

Cardiovascular emergencies
Heart attacks, aortic dissections require emergency surgery restore blood flow.
Some common emergency surgical procedures
1. Exploratory laparotomy

 Performed to examine and diagnose abdominal conditions.

 Making one large incision in the abdomen to gain access to the organs and
tissues within.

Indicated for abdominal conditions such as:

Abdominal pain, abdominal trauma, bowel obstruction
Unexplained bleeding, peritonitis
For hysterectomy and removal of the ovaries or fallopian tubes.
Exploratory laparotomy procedure
Incision

 The surgeon makes an incision in the abdominal wall usually along the
midline or in a location specific to the suspected problem.
Exploration

 The surgeon carefully examines abdominal and reproductive organs.

 Then identify any abnormalities or sources of concern.

Treatment
 If any issues are identified appropriate measures are taken.
Closure
 Finally the surgeon closes the incision using sutures or staples.
2. Laparoscopy
 Used to examine the organs inside the abdomen or other closed spaces.

 A surgeon uses laparoscope to look at the abdominal organs.

 A laparoscope is a long, thin tube with a high intensity light and a high
resolution camera at the front.

 It allows to see inside your body in real time in a small incisions.

 Usually performed when noninvasive methods are failed to diagnosis.

 Important for both diagnostic and treatment of certain conditions.

Laparoscopy procedure
Incisions
 Several small incisions made in the abdomen for entry of the laparoscope
and surgical instruments.
Insertion of laparoscope
 Inserted through one of the incisions& provide video of the abdominal
organs.
Exploration and treatment

 Specialized instruments inserted through the other incisions to manipulate

and treat the organs as needed; finally the incisions are closed using suture.
3. Thoracotomy

 Involves making a large incision in the chest wall to gain access to thoracic
cavity organs.

 Example the lungs, heart, or major blood vessels.

 Typically performed for more complex and invasive surgeries.

 such as lung resection and repair of major chest trauma or removal of

tumors.

 It allows direct visualization and manipulation of the organs.

Surgical procedure for thoracotomy
 Large incision is made in the chest wall between the ribs.

 Size and location of the incision depend on the specific surgical needs.

 The incision allows access to the thoracic cavity

 The ribs may be spread apart for better visibility and access to the organs.

 Directly visualize and manipulate the organs within the thoracic cavity.

 Perform lung resection, repair of damaged organs & blood vessels.

 Finally the incision is closed using sutures or staples.

4. Thoracostomy
 Procedure that involves the placement of a chest tube into the pleural
space.

 To drain air, fluid, or blood and restore normal lung function.

Indications for thoracostomy

Pneumothorax air accumulates in the pleural space ; lung to collapse.

Pleural effusion accumulation of fluid in the pleural space due to CHF,

pneumonia, or cancer.

Hemothorax occurs when blood accumulates in the pleural space due to

trauma or injury.
Thoracostomy procedure
Incision

 Small incision is made on the chest wall, usually in the mid-axillary line.

 This provides access to the pleural space.

Insertion of chest tube

 Hollow tube is inserted through the incision and into the pleural space.

 The tube connected to a drainage system for the removal of air, fluid.

Securing the chest tube

 The chest tube is secured in place using sutures or adhesive dressings.

Cont…

Monitoring and drainage

 The drainage system connected to the chest tube is monitored.

 For proper functioning and adequate drainage of air and fluid.

Removal of the chest tube

 Once the underlying condition has resolved the chest tube is removed.

 Typically done by gently pulling while the patient exhales forcefully.

5. Colotomy
 Making an incision into the colon to access and treat a specific area.

Indications for colotomy

 Severe diverticulitis to drain abscesses or remove affected sections.

 Diverticulitis infection of small pouches in the colon called diverticula.

 Severe injuries to the colon require it to repair or remove damaged.

 Performed to remove a tumor or growth located within the colon.

Surgical procedure for colotomy
 An incision is made into the abdomen to access the colon.

 The location and size of the incision depend on the specific surgical needs.

 The surgeon carefully exposes the affected area of the colon.

 Depending on the indication for colotomy, various procedures can be

performed.

 Involve excising the affected area, suturing or stapling the colon, or creating
anastomosis.
6. Appendectomy

 Surgical procedure that involves the removal of the appendix.

 Performed to treat appendicitis and prevent complications such as rupture.

 Appendicitis occurs when the appendix becomes blocked.

 Appendectomy can be performed laparoscopically or laporatomically.

 If the appendix already ruptured appendectomy on same day.

 Small incision is made in the lower right side of the abdomen.

 Surgeon carefully identifies and isolates the appendix and then removes it.
Emergency Cesarean section

It is done to avert potential loss of life of the mother, newborn or both.

Undergone if there is umbilical cord prolapse, abruptio placentae, PP in

active hemorrhage, pre-rupture syndrome, uterine rupture NRFHRP etc.

Good multidisciplinary communication is pivotal in the management of an

emergency Cesarean section for good feto-maternal outcome.

Emergency Cesarean section can pose many challenges to the attending

anesthetist.
Cesarean Section Procedure

Prior to the surgery, a patient will receive anesthesia, which is usually GA.

Screen placed to keep the patient from seeing directly into the incision.

Make the initial incision into the abdomen usually vertical incision in
emergencies.
Follow-Up Incisions

Multiple layers that a surgeon must go through before reaching the baby
includes cutting through the skin, fat, into the abdomen, and uterus.

The bladder and intestines may need to be pushed aside, as well.

The abdominal muscles won't be cut simply separated.

Suctioning of Amniotic Fluids

After cutting through the uterus, the amniotic fluid will be suctioned away
to make a bit more room in the uterus for the hands or instruments.
Delivery of Baby's Head

Baby is often engaged in the pelvis, usually, head down and will be lifted
out by the surgeon.

The patient may feel pressure or pulling at this point.

Once the head is out the surgeon will suction the baby's nose and mouth for
fluids.

If meconium is present there may be extra suctioning required.

Delivery of Baby's Shoulders and Body

The surgeon will need to maneuver the baby back and forth to help them
emerge.

The assistant surgeon pressing on the upper part of abdomen to assist in the
birth.
Baby Is Born

It's been about 5 to 10 minutes since the surgery started.

After delivery the umbilical cord will be cut, and then, the baby is taken
away to a nearby warmer.
Delivery of the Placenta

After cord cutting the placenta will be delivered.

Followed by the suturing of the uterus and all the layers.

Finally the surgeon will stitch the incision shut with dissolving stitches.
 Dilatation and Curettage (D&C)

is a minor operation in which the cervix is dilated (expanded).

the cervical canal and uterine lining can be scraped with a curette.

In the operational setting is often required to resolve complications of early

pregnancy loss.

Of particular importance is noting whether the cervix leads directly into the
uterus or whether there is any angulation anterior or posterior.
Salpingectomy
• Surgical removal of the fallopian tube.

• is uniformly effective, safe, simple, fast, and well within the capabilities of
an abdominal surgeon.

• disadvantages are that it results in the loss of the tube and may be more
surgery than is needed.

• After opening the abdomen identify the fallopian tube containing the
ectopic.

• Grasp the tube with Babcock clamps and elevate the tube.
salpingostomy.

A incision along the anti-mesenteric border of the tube.

The pregnancy is extruded through the incision and the tube observed for
further bleeding.

The tube may be reclosed with very fine absorbable suture or simply left
open.
Oophorectomy

An oophorectomy is a surgical procedure to remove one or both of

ovaries.

An oophorectomy may be performed for:

Ovarian cancer

Endometriosis

Noncancerous (benign) ovarian tumors or cysts

Reducing the risk of ovarian cancer or breast cancer in those at increased

risk

Ovarian torsion — the twisting of an ovary

Ovarian Cystectomy

is surgery to remove a cyst from the ovary.

is usually necessitated because of either severe pain or hemorrhage.

the cyst can often be "shelled out" from the ovary allowing ovarian
conservation.

Has two repairing layers

a deeper layer to assure hemostasis, and
a second superficial layer to approximate the edges of the ovarian
capsule.
Colectomy is used to treat and prevent diseases
Bleeding that can't be controlled
Bowel obstruction
Colon cancer
Hysteroscopy

Hysteroscopy is primarily used to diagnose and treat the causes

of abnormal uterine bleeding.

is done using a hysteroscope, a thin, lighted tube that’s inserted into vagina
to examine cervix and the inside of uterus.

 An operative hysteroscopy can be used to remove polyps, fibroids and

adhesions.
Hysterectomy

• Hysterectomy is the partial or total surgical removal of the uterus.

• is normally recommended as a last resort after pharmaceutical or other

surgical options was failed.

• It may needed in
Endometriosis
Adenomyosis
Heavy menstrual bleeding
Uterine prolapse
types

Radical hysterectomy:

• complete removal of the uterus, cervix, upper vagina, and parametrium.

Total hysterectomy:

• complete removal of the uterus and cervix, with or without oophorectomy.

Subtotal hysterectomy:

• removal of the uterus, leaving the cervix in situ.

technique

In modern medicine today, laparoscopic vaginal and total laparoscopic

techniques have been developed.

Abdominal hysterectomy

• Most hysterectomies are done via laparotomy

• A transverse incision is made through the abdominal wall,

• This technique allows the greatest access to the reproductive structures.

• The recovery time for an open hysterectomy is 4–6 weeks

Vaginal hysterectomy

• is performed entirely through the vaginal canal

• has clear advantages over abdominal surgery