Resumen
El término abdomen agudo engloba una serie de cuadros clínicos que tienen en común el dolor abdominal intenso, a menudo de aparición súbita, la alteración del tránsito intestinal y la afectación del estado general, y que suelen requerir cirugía urgente. Existen enfermedades no quirúrgicas que pueden cursar con sintomatología parecida; por ello, lo más importante es establecer si es necesaria o no la cirugía y si esta debe ser urgente o diferida. El abdomen agudo quirúrgico puede ser, fundamentalmente, de origen inflamatorio (apendicitis, colecistitis, diverticulitis), perforativo (perforación de úlcera péptica, perforación intestinal), obstructivo (oclusión de intestino delgado o colon) y hemorrágico (traumatismo, embarazo ectópico). En esta actualización se revisan los cuadros más frecuentes de cada tipo (apendicitis, perforación de víscera hueca, obstrucción por neoplasia de colon y traumatismo abdominal) y una situación especial, la de la mujer embarazada que necesita un manejo con ciertas peculiaridades, tanto para el diagnóstico como para el tratamiento.
Palabras clave
Abdomen agudo
Apendicitis aguda
Perforación de víscera hueca
Cáncer de colon obstructivo
Traumatismo abdominal
Abstract
Acute abdomen refers to several different situations characterized by severe abdominal pain, frequently sudden onset, changes in the intestinal transit and general health impairment; usually urgent surgery is required. Because other non-surgical diseases with similar symptomatology can occur, it is very important to assess whether the necessity of the surgery as well as its emergency. Usually surgical acute abdomen may be caused by inflammation (appendicitis, cholecystitis, and diverticulitis), perforation (peptic ulcer perforation, intestinal perforation), obstruction (small bowel or colon obstruction), and hemorrhagic (traumatism, ectopic pregnancy). In this paper the most frequent presentations (appendicitis, hollow viscera perforation, neoplastic colon obstruction and abdominal traumatism) of each cause are reviewed, as well as acute abdomen in pregnant women, because it requires a specific approach in diagnosis and in treatment.
Keywords
Acute abdomen
Acute appendicitis
Hollow viscera perforation
Obstructive colon cancer
Abdominal traumatism
Identifíquese
¿Aún no es suscriptor de la revista?
Comprar el acceso al artículo
Comprando el artículo el pdf del mismo podrá ser descargado
Teléfono para incidencias
De lunes a viernes de 9h a 18h (GMT+1) excepto los meses de julio y agosto que será de 9 a 15h
Llamadas desde España
932 415 960
Llamadas desde fuera de España
+34 932 415 960
Bibliografía
[2]
Cirugía clínica., Masson, S.A.,
[3]
The evidence of the ten most common surgical interventions in the United States from 1970 to 2018.
Ann Surg., (2019), 270 pp. e16-e17
[4]
J.M. Havens, P.U. Neiman, B.L. Campbell, M.A. Croce, D.A. Spain, L.M. Napolitano.
The future of emergency general surgery.
Ann Surg., (2019), 270 pp. 221-222
[6]
Demonstrations of physical signs in clinical surgery, Butterworth Heinemann,
[7]
Source Control: a guide to the management of surgical infections., Springer-Verlag,
[8]
Schein's common sense emergency abdominal surgery., 4th ed., Springer,
[9]
J Ultrasound Med., (2010), 29 pp. 1457-1468
[10]
J Visc Surg., (2010), 147 pp. e129-e135
[11]
Abdominal emergencies during pregnancy.
J Visc Surg., (2015), 152 pp. S105-S115
[12]
Surgical emergencies in the pregnant patient.
Adv Surg., (2019), 53 pp. 161-177
[13]
SAGES guidelines for the use of laparoscopy during pregnancy.
Surg Endosc., (2017), 31 pp. 3767-3782
[14]
Committee Opinion No. 696: Nonobstetric surgery during pregnancy.
Obstet Gynecol., (2017), 129 pp. 777-778
[15]
Obstet Gynecol., (2019), 133 pp. e285-e286
[16]
F. Agresta, L. Ansaloni, G.L. Baiocchi, C. Bergamini, F.C. Campanile, M. Carlucci, et al.
Laparoscopic approach to acute abdomen from the Consensus Development Conference of the Società Italiana di Chirurgia Endoscopica e nuove tecnologie (SICE), Associazione Chirurghi Ospedalieri Italiani (ACOI), Societá Italiana di Chirurgia (SIC), Societá Italiana di Chirurgia d’Urgenza e del Trauma (SICUT).
Societá Italiana di Chirurgia nell’Ospedalitá Privata (SICOP), and the European Association for Endoscopic Surgery (EAES). Surg Endosc., (2012), 26 pp. 2134-2164
[17]
Reproductive outcome after anesthesia and operation during pregnancy: a registry study of 5405 cases.
Am J Obstet Gynecol., (1989), 161 pp. 1178-1185
[18]
G.H. Guyatt, E.A. Akl, M. Crowther, D.D. Gutterman, H.J. Schuünemann.
American College of Chest Physicians Antithrombotic Therapy and Prevention of Thrombosis Panel. Executive summary: antithrombotic therapy and prevention of thrombosis. 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines.
Chest., (2012), 141
[19]
J Coll Physicians Surg Pak., (2018), 28 pp. 875-878
[20]
Management, treatment and outcomes of acute appendicitis in an elderly population: a single-center experience.
Eur J Trauma Emerg Surg., (2017), 43 pp. 723-727
[21]
Acute appendicitis in the elderly in the twenty-first century.
J Gastrointest Surg., (2015), 19 pp. 730-735
[22]
Value of laparoscopic appendectomy in the elderly patient.
World J Surg., (2009), 33 pp. 918-922
[23]
E. Lietzen, P. Salminen, I. Rinta-Kiikka, H. Paajanen, T. Rautio, NordstömP, et al.
The accuracy of the computed tomography diagnosis of acute appendicitis: does the experience of the radiologist matter?.
Scand J Surg., (2018), 107 pp. 43-47
[24]
Differences in the clinical course of acute appendicitis in the elderly in comparison to younger population.
Pol Przegl Chir., (2016), 88 pp. 142-146
[25]
Clinical management of appendicitis.
Visc Med., (2018), 34 pp. 453-458
[26]
Antibiotics-first strategy for uncomplicated acute appendicitis in adults is associated with increased rates of peritonitis at surgery. A systematic review with meta-analysis of randomized controlled trials comparing appendectomy and non-operative management with antibiotics.
Surgeon., (2017), 15 pp. 303-314
[27]
Surg Clin North Am., (2014), 94 pp. 35-41
[28]
Epidemiology, diagnosis, and management of esophageal perforations: systematic review.
Dis Esophagus., (2017), 30 pp. 1-6
[29]
M. Chirica, M.D. Kelly, S. Siboni, A. Aiolfi, C.G. Riva, E. Asti, et al.
Esophageal emergencies: WSES guidelines.
World J Emerg Surg., (2019), 14 pp. 26
[30]
Spectrum of oesophageal perforations and their influence on management.
Br J Surg., (2014), 101 pp. e156-e162
[31]
G. Loske.
Endoscopic negative pressure therapy of the upper gastrointestinal tract.
Chirurg., (2019), 90Suppl1 pp. 1-6
[32]
Outcomes following the main treatment options in patients with a leaking esophagus: a systematic literature review.
Dis Esophagus., (2017), 30 pp. 1-10
[33]
Thoracoscopic primary esophageal repair in patients with Boerhaave's syndrome.
Ann Thorac Surg., (2011), 91 pp. 1552-1555
[35]
Surg Clin North Am., (2014), 94 pp. 31-34
[36]
Lancet., (2017), 390 pp. 613-624
[37]
G.A. Paspatis, J.M. Dumonceau, M. Barthet, S. Meisner, A. Repici, B.P. Saunders, et al.
Diagnosis and management of iatrogenic endoscopic perforations: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement.
Endoscopy., (2014), 46 pp. 693-711
[38]
Gastric perforation as a complication of intragastric balloon.
Surg Obes Relat Dis., (2018), 14 pp. 719-722
[39]
Gastrointestinal traumatic injuries: gastrointestinal perforation.
Crit Care Nurs Clin North Am., (2018), 30 pp. 157-166
[40]
Strategies to improve the outcome of emergency surgery for perforated peptic ulcer.
Br J Surg., (2014), 101 pp. 51-64
[41]
Global patterns and trends in colorectal cancer incidence and mortality.
Gut., (2017), 66 pp. 683-691
[42]
Oncologic outcomes of self-expanding metallic stent insertion as a bridge to surgery in the management of left-sided colon cancer obstruction: comparison with nonobstructing elective surgery.
World J Surg., (2009), 33 pp. 1281-1286
[43]
A. Kleespies, K.E. Füessl, H. Seeliger, M.E. Eichhorn, M.H. Müller, M. Rentsch, et al.
Determinants of morbidity and survival after elective non-curative resection of stage IV colon and rectal cancer.
Int J Colorectal Dis., (2009), 24 pp. 1097-1109
[44]
H. Markogiannakis, E. Messaris, D. Dardamanis, N. Pararas, D. Tzertzemelis, P. Giannopoulos, et al.
Acute mechanical bowel obstruction: clinical presentation, etiology, management and outcome.
World J Gastroenterol., (2007), 13 pp. 432-437
[45]
Management of malignant large-bowel obstruction.
Dis Colon Rectum., (2019), 62 pp. 1028-1030
[46]
M. Pisano, L. Zorcolo, C. Merli, S. Cimbanassi, E. Poiasina, M. Ceresoli, et al.
2017 WSES guidelines on colon and rectal cancer emergencies: obstruction and perforation.
World J Emerg Surg., (2018), 13 pp. 36
[47]
M. Frasson, B. Flor-Lorente, J.L. Rodríguez, P. Granero-Castro, D. Hervás, M.A. Álvarez-Rico, et al.
Risk factors for anastomotic leak after colon resection for cancer: multivariate analysis and nomogram from a multicentric, prospective, national study with 3193 patients.
Ann Surg., (2015), 262 pp. 321-330
[48]
J.E. Van Hooft, E.E. van Halsema, G. Vanbiervliet, R.G. Beets-Tan, J.M. DeWitt, F. Donnellan, et al.
Self-expandable metal stents for obstructing colonic and extracolonic cancer: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline.
Endoscopy., (2014), 46 pp. 990-1053
[49]
Is mechanical bowel preparation mandatory for left-sided colonic anastomosis?.
Results of a prospective randomized trial. Tech Coloproctol., (2006), 10 pp. 131-135
[50]
Morbidity and mortality of the Hartmann procedure for diverticular disease over 18 years in a single institution.
Colorectal Dis., (2012), 14 pp. e492-e498
[51]
Screening laboratory and radiology panels for trauma patients have low utility and are not cost effective.
J Trauma., (2008), 65 pp. 1114-1116
[52]
Am Surg., (2017), 83 pp. 1193-1202
[53]
P.J. Chestovich, T.D. Browder, S.L. Morrissey, D.R. Fraser, N.K. Ingalls, J.J. Fildes.
Minimally invasive is maximally effective: diagnostic and therapeutic laparoscopy for penetrating abdominal injuries.
J Trauma Acute Care Surg., (2015), 78 pp. 1076-1083
[54]
E.L. Jones, R.T. Stovall, T.S. Jones, D.D. Bensard, C.C. Burlew, J.L. Johnson, et al.
Intra-abdominal injury following blunt trauma becomes clinically apparent within 9hours.
J Trauma Acute Care Surg., (2014), 76 pp. 1020-1023
[55]
Selective nonoperative management in 1106 patients with abdominal gunshot wounds: conclusions on safety, efficacy, and the role of selective CT imaging in a prospective single-center study.
Ann Surg., (2015), 261 pp. 760-764
[56]
Selective nonoperative management of abdominal gunshot wounds from heresy to adoption: a multicenter study of the Research Consortium of New England Centers for Trauma (ReCoNECT).
J Am Coll Surg., (2017), 224 pp. 1036-1045
[57]
D.J. Roberts, N. Bobrovitz, D.A. Zygun, C.G. Ball, A.W. Kirkpatrick, Faris Pd, et al.
Indications for use of damage control surgery in civilian trauma patients: a content analysis and expert appropriateness rating study.
Ann Surg., (2016), 263 pp. 1018-1027
