Skip to main content Accessibility help
×
Home
  • Print publication year: 2013
  • Online publication date: November 2013

54 - Pneumonia

from Section 9 - Infectious disease emergencies

Summary

This chapter discusses the diagnosis, evaluation and management of acute mesenteric ischemia. The diagnosis should be considered in those older than 50 years, presenting with nonspecific abdominal pain and risk factors for the disease. The physician must have a high index of suspicion as the history of the disease may be difficult to obtain. The chapter lists clinical presentations of the subtypes of mesenteric ischemia. Emergent laparotomy is indicated, especially if signs of peritonitis are present. Surgery is generally the standard of care for mesenteric arterial embolism and thrombosis. Surgery is done to determine the extent of damage, to find the underlying cause, to revascularize viable bowel, and to resect infarcted bowel. Second-look procedures are often performed 24-48 hours after the initial surgery in order to restore continuity and assess extension of ischemia to ensure that at-risk or ischemic bowel is not used for the final anastomosis.

References

American Thoracic Society, Infectious Diseases Society of America. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med. 2005; 171: 388–416.
AriasE, SmithBL. Deaths: preliminary data for 2001. Natl Vital Stat Rep. 2003; 51: 1–44.
MandellLA, BartlettJG. Update of practice guidelines for management of patients with community-acquired pneumonia. Clin Infect Dis. 2007; 37: 1405–33.