Acute Abdomen (Disease & Non-Battle Injury)

Objectives

To provide guidance for surgical decision making when assessing Disease Non-Battle Injury (DNBI) acute abdomen in a deployed setting with regards to:

a) Resource limitation 

b) Limited or no access to imaging 

c) Multiple casualties to assess safest to transfer.

This guideline will not direct surgical steps for acute abdomen.

Scope

These guidelines are for deployed surgeons to aid decision making for treatment of the acute abdomen. Other personnel who have diagnosed a potential acute abdomen should refer to surgeons.

Audience

Deployed surgical staff and key decision makers for transfer or resource utilisation.

Initial Assessment & Management

Non-operative management (NOM) consists of antibiotics (typically intravenous for a minimum of 24 hours), fluids and repeated examination.

Advanced Assessment & Management

*Uncommon in deployed military age population.  

UGI – Upper Gastrointestinal

NOM – Non-operative management

Prolonged Casualty Care

Consideration for exploratory laparotomy should be made when no imaging is available and prolonged casualty care expected.  A missed diagnosed of perforated disease can carry more morbidity and mortality risk than a non-therapeutic laparotomy.

Paediatric Considerations

Diagnoses of DNBI acute abdomen in children are outside the scope of this CGO. The flow chart can be used to guide decision making but not diagnosis.