Contrast radiography: an aid to postoperative management

Modern aids to clinical decision-making in the acute abdomen

Acute abdominal pain continues to provide not only a large workload for the general surgeon but also many diagnostic and management problems. Many different techniques have been introduced over the past two decades to help in the management of the acute abdomen and this review considers their relative claims to become incorporated into the process of clinical decision-making. The evidence in support of formally structured patient interview pathways with or without computer-aided diagnostic programs is now overwhelming and should become routine. Both laparoscopy and peritoneal cytology have an important role to play in the management of patients in whom the decision to operate is in doubt, and a combination of the two would be complementary. Ultrasonography has become increasingly popular for investigating the acute abdomen, and results from specialist centres are impressive. However, the problems of operator variation and the difficulties in providing a 24-h service will probably prevent it from becoming a first-line investigation in most hospitals. Although plain radiography has been available for many years, its routine use in the management of the acute abdomen remains controversial. Recent studies have confirmed that contrast radiography is an important adjunct to decision-making, particularly in the management of large bowel obstruction, and there is increasing evidence to support its use in suspected small bowel obstruction, perforated peptic ulcer and acute diverticular disease.

Gastrointestinal motility studies as a guide to postoperative management

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Postoperative Stasis after Vagotomy and Pyloroplasty

Thirty-two patients who had vagotomy and pyloroplasty performed for duodenal ulcer or its complications have been assessed after operation by the use of a simple radiological test of gastric emptying. Twenty-seven showed emptying at 24 hours after operation, and this finding was used as a guide to beginning the administration of oral fluids and tube withdrawal. Eight cases of stasis are discussed.