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Perforated Viscous, Emergency Medicine

Reviewed 06/2017
 


Basics

Description

  • Perforation/break in the containing walls of an organ with contents spilling into peritoneal cavity

  • Inflammation/infection

  • Ulceration

  • Shearing/crushing or bursting forces in trauma

  • Obstr...

Diagnosis

Signs and Symptoms

  • Sudden severe abdominal pain:

    • Initially local

    • Often rapidly becoming diffuse due to peritonitis

    • Consider persistent local pain due to abscess/phlegmon formation

  • Rigidity

  • Guardin...

Treatment

Pre-Hospital

Initiate IV fluids for patients with history of vomiting or abnormal vital signs. 

Initial Stabilization/Therapy

Treat hypotension/tachycardia with 0.9% normal saline: 
  • Adults: 500 ...

Follow-Up

Disposition

Admission Criteria

Suspected or confirmed perforation requires admission and immediate surgical consultation. 

Discharge Criteria

Discharge not applicable in this situation, as acute...

Pearls and Pitfalls

  • Obtain upright CXR and abdominal radiographs for patients with suspected perforated viscous.

  • CXR without free air does not rule out perforation

  • If high clinical suspicion for perfora...

Additional Reading

  • Gans  SL, Stoker  J, Boermeester  MA. Plain abdominal radiography in acute abdominal pain; past, present, and future. Int J Gen Med.  2012;5:525–533.

  • Langell  JT, Mulvihill  SJ....

Codes

ICD9

  • 533.50 Chronic or unspecified peptic ulcer of unspecified site with perforation, without mention of obstruction

  • 562.11 Diverticulitis of colon (without mention of hemorrhage)

  • 868.00 Injury to ...

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