Special EGS Populations

Pediatric Emergency General Surgery

The fellow should be able to:
  • Demonstrate an understanding of the unique pediatric physiology
  • Demonstrate an understanding of the role of imaging in pediatric general surgery and the consequences of ionizing radiation exposure
  • Recognize the differences and similarities in the management of acute appendicitis
  • Understand indications and treatment of pyloric stenosis
  • Understand the treatment options for treatment of intussusception
  • Understand the indications for transfer to a children’s hospital
  • Procedure/multimedia
Resources
  • Topic Summary
  • Additional Resources:
    • Maita S, Andersson B, Svensson JF, Wester T. Nonoperative treatment for nonperforated appendicitis in children: a systematic review and meta-analysis. Pediatr Surg Int. 2020 Mar;36(3):261-269. doi: 10.1007/s00383-019-04610-1. Epub 2019 Dec 14. PMID: 31838546; PMCID: PMC7012795
    • Lin LH, Lee CY, Hung MH, Chen DF. Conservative treatment of adhesive small bowel obstruction in children: a systematic review. BMJ Open. 2014 Sep 15;4(9):e005789. doi: 10.1136/bmjopen-2014-005789. PMID: 25223569; PMCID: PMC4166136.
    • Robinson JR, Correa H, Brinkman AS, Lovvorn HN 3rd. Optimizing surgical resection of the bleeding Meckel diverticulum in children. J Pediatr Surg. 2017 Oct;52(10):1610-1615. doi: 10.1016/j.jpedsurg.2017.03.047. Epub 2017 Mar 23. PMID: 28359587; PMCID: PMC5610599.
    • Gibbs H, Jatana KR. Pediatric Button Battery Injuries-Current State and What's Next? JAMA Otolaryngol Head Neck Surg. 2022 Jul 1;148(7):683-685. doi: 10.1001/jamaoto.2022.0849. PMID: 35616959.

Emergency General Surgery During Pregnancy

The fellow should be able to:
  • Demonstrate an understanding of the unique physiology of pregnant patients and how this pertains to general surgery
  • Demonstrate an understanding of the role of imaging during pregnancy
  • Recognize the role of fetal monitoring and risks to the fetus in emergency general surgery
  • Demonstrate an understanding of the treatment of appendicitis during pregnancy
  • Demonstrate an understanding of the treatment of gallbladder disease during pregnancy
  • Demonstrate an understanding of the treatment of umbilical/ventral hernias during pregnancy
  • Describe changes to operative approach necessary during surgery in the pregnant patient

Emergency General Surgery in the Older Adult Patient

The fellow should be able to:
  • Demonstrate an understanding of the unique physiology of the elderly patient
  • Demonstrate an understanding of consequences of age on outcome in emergency surgery
  • Recognize the importance of prognostication and risk assessment in emergency general surgery
  • Understand the indications for palliative care evaluation in emergency surgery in the elderly
Resources
  • Topic Summary

Emergency General Surgery in the Cirrhotic Patient

The fellow should be able to:
  • Demonstrate an understanding of the unique physiology of cirrhotic patients
  • Demonstrate an understanding of the consequences of cirrhosis on surgical outcomes and the use of MELD and other scoring systems for prognostication
  • Demonstrate an understanding of how to manage ascites following surgery in a cirrhotic patient
  • Demonstrate an understanding of the treatment of gallbladder disease in cirrhosis
  • Demonstrate an understanding of the treatment of umbilical/ventral hernias in cirrhotic patients
  • Demonstrate an understanding of the treatment of inguinal hernias in cirrhosis
Resources

Emergency General Surgery in the Obese Patient and Post-Bariatric Surgery Patient

The fellow should be able to:
  • Demonstrate an understanding of the unique physiology of obese patients
  • Demonstrate an understanding of the consequences of obesity on surgical outcomes
  • Demonstrate an understanding of diagnosis and management of surgical complications following bariatric surgery including internal hernias and marginal ulcers
  • Describe options for the management of choledocholithiasis in a patient following gastric bypass surgery
  • Demonstrate an understanding of the emergent treatment of umbilical/ventral hernias in obese patients
Resources
  • Topic Summary
  • AAST Education Module - Acute Care Surgery Problems in the Post-Bariatric Surgery Patient
  • Additional Resources:
    • Chousleb E, Chousleb A. “Management of post-bariatric surgery emergencies.” J Gastrointest Surg 2017;21(11):1946-53.
    • Lim R, Beekley A, Johnson DC etal. “Early and late complications of bariatric operation.” Trauma Surg Acute CareOpen 2018;3(1):e000219.
    • Kassir R, Debs T, Blanc P etal. “Complications of bariatric surgery: Presentation and emergency management.” Int J Surg 2016;27:77-81.
    • Wernick B, Jansen M, Noria S etal. “Essential bariatric emergencies for the acute care surgeon.” Eur J Trauma Emerg Surg 2016;42(5):571-84.

Unexpected Malignancy in EGS

The fellow should be able to:
  • TBA
Resources:

Surgery in Immunocompromised Patients

The fellow should be able to:

  • TBA

Resources

  • Topic Summary
  • Overview Article:
    • Coccolini F, Improta M, et al. Acute abdomen in the immunocompromised patient: WSES, SIS-E, WSIS, AAST, and GAIS guidelines. World J Emerg Surg. 2021 Aug 9;16(1):40.
  • Additional Resources:
    • Abu-Sbeih H, Ali FS, et al. Neutropenic Enterocolitis: Clinical Features and Outcomes. Dis Colon Rectum. 2020 Mar;63(3):381-388. 
    • Batra R, Rudnicki Y, et al. Management of Diverticulitis in Renal Transplant Patients. Am Surg. 2023 Feb;89(2):210-215. 
    • Fishman JA. Infection in Organ Transplantation. Am J Transplant. 2017 Apr;17(4):856-879. 
    • Mahmood A, Raza SH, et al. Acute appendicitis in people living with HIV: What does the emergency surgeon needs to know? SAGE Open Med. 2021 Jan 28;9:2050312120982461.
    • Tejiram, S., Sava, J.A. (2019). Emergency General Surgery in the Immunocompromised Surgical Patient. In: Brown, C., Inaba, K., Martin, M., Salim, A. (eds) Emergency General Surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-96286-3_42

Thoracic Issues in General Surgery

The fellow should be able to:
  • Demonstrate an understanding of the management of spontaneous pneumothorax
  • Demonstrate an understanding of the management of parapneumonic effusions and empyema
  • Describe the options for management of empyema including medical management and surgical treatment
  • Describe the treatment for lung abscesses including hydatid and bacterial causes
  • Demonstrate an understanding of the management of symptomatic malignant pleural effusions
  • Describe the management of pancreaticopleural fistulas
  • Understand the management of chylothorax
  • Understand the management of non-traumatic pericardial effusions and infectious pericarditis
Resources