㆒般外科常見疾病(㆒) - 臺北榮民總醫院

㆒般外科常見疾病(㆒)
國立陽明大㈻ ㊩㈻系外科
台北榮民總㊩院 ㆒般外科
龍藉泉

Acute Appendicitis
Most common surgical acute
abdomen
Incidence : 20~30 y/o most common

Etiology of Acute Appendicitis
Obstruction - due to fecalith
Hypertrophy of lymphoid tissue
Inspissated barium
Vegetable and fruit seeds
Intestinal worms - ascarids

Symptoms of Acute Appendicitis
Shifting abdominal pain
Nausea, Vomiting
Diarrhea

Shifting Abdominal Pain

Nausea, Vomiting, Why?

Signs of Acute Appendicitis
Mcburney’s point tenderness
Rebounding pain and muscle
rigidity.
Rovsing’s sign
Psoas sign
Obturator’s sign

Mcburney’s point tenderness

Obturator’s Sign

Psoas’s Sign

Treatment of Acute Appendicitis
• Open appendectomy
• Laparoscopic appendectomy
• Partial cecotomy
• Right hemicolectomy
• Pig-tail drainage
• Surgical drainage
• Antibiotics

Hernia
• ( a Latin term, that means rupture of a
proportion of a structure )

Etiology of Hernia
• Anatomical factors
• Congenital factors
• Biological factors
– Malnutrition
– Environmental toxins
– Athletics
– Iatrogenic factors

• History
Diagnosis of Hernias
• Physical Examination - most important
• Radiological findings -
Chest PA, KUB, Herniography,
Ultrasonography, CT

Incarcerated?
Strangulated?
Sliding?

Groin Hernia
• Indirect inguinal hernia - the most
prevalent type of hernia in the infant,
children, and adult.
• Femoral hernia - more common in
the adult female

Anterior view of inguinal region

Posterior view of Inguinal Region

Indication for Hernioplasty
• All hernias should be repaired unless
local or systemic condition is not
permitted.
• Trusses and surgical belt are helped in
the management of small hernias unless
operation is contraindicated.
• Trusses are contraindicated for
patients with femoral hernia.

Treatments of Hernia
• Truss
• Hernioplasty
Anterior approach
posterior approach
Prosthesis

Complications of Inguinal
Hernioplasty
• Ischemic orchitis
• Testicular atrophy
• Neuralgia
• Recurrence

Hernia Truss

Small Intestine
• Accounts for 70% to 80% of the
length of the gastrointestinal tract

Indication of the Surgery
• Bleeding
• Obstruction
• Perforation
• Malignancy
for Intestine

Diseases of the Intestine
• Inflammatory disease
• Neoplasm
• Diverticular disease
• Vascular disease
• Intestinal obstruction
• Miscellaneous

Meckel’s Diverticulum
• Incomplete closure of
omphalomesenteric duct (vitelline duct)
• Locating on the terminal ileum, 50 to
70 cm proximal to the ileocecal valve.
• Heterotopic gastric or pancreatic
tissues is often found.

Meckel’s Diverticulum

Meckel’s Diverticulum

Intestinal Obstruction (1)
Mechanical obstruction of the lumen
• Obturation of the lumen – Meconium,
Intussusception, Gall stones, Impaction
• Lesions of bowel – Congenital, Traumatic,
Inflammatory, Neoplastic, miscellaneous
• Lesions extrinsic to the bowel – Adhesive
band, Hernia, wound dehiscence, Extrinsic
masses
• Vovulus

Intestinal Obstruction (2)
Inadequate propulsive motility
• Neuromuscular defects – Megacolon,
Paralytic ileus, Spastic ileus
• Vascular Occlusion

Vascular disease of the Intestine
• Mesenteric vascular disease
• Submucosal vascular anomaly

Mesenteric vascular disease
• Arterial
• Acute
• Occlusive
of the Intestine
• Venous
• Chronic
• Nonocclusive

Blind Loop Syndrome
• Bacterial overgrowth in stagnant areas of small
intestine.
• Bacteria compete for Vit.B12, Vit.B12 absorption
decrease, megaloblastic anemia may appeared.
• Schilling test ( 60 Co-labeled B12 absorption) with or
without administration of tetracycline is the
diagnostic method.
• Surgical correction of stagnation is indicated and
effective.

Short Bowel Syndrome
• If terminal ileum and ileocecal valve
present, resection up to 70% is tolerated.
• Proximal bowel resection is tolerated
better than the distal resection.
• Nutritional support is the main treatment.
• Surgical operation is still under debate