Clinical Features

Initial Management

  1. Like many surgical emergencies this is mainly fluid balance in the first instance
  2. These patients are usually in agony from the chemical / bacterial peritonitis and require sensible doses of morphine.  Use 10mg of Morphine in 10mls H2O and give in 3-4ml doses every 10-15 mins until comfortable if required.
  3. Large bore 14G (brown) venflon, 2 litres of crystalloid to be run in relatively quickly
  4. NG tube to empty stomach, catheter
  5. Blood for G+S, FBC, U&E, ABG, and blood cultures
  6. Erect CXR,
  7. Consider CT. USS can be very useful in experienced hands
  8. Peritoneal lavage in blunt trauma has a role, CT first though
  9. If fluid balance is a problem make arrangements to insert a central line to guide replacement
  10. Antibiotics are indicated - use local policies

Continuing Management

  1. Laparotomy is usually indicated – inform theatre and anaesthetist
  2. Initial laparoscopy if experienced enough may prevent the need for laparotomy at al or at least target the incision
  3. If space is available and in appropriate circumstances the patient can be transferred pre-operatively to the HDU for optimisation.
  4. Don’t forget DVT prophylaxis

Potential Post-operative Complications