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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_725_Библиотеки_им_академика_М_И_Перельмана
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Mumbai, Karachi, Cairo, Belgrade, Soweto, Mexico City, Kiev,
Copenhagen,Philadelphia,Glasgow,Krakow and, yes — even in Paris
(wehope there area few Frenchsurgeons who can,andwant to,read
English…).
Ifyouareasurgeonwhopracticesthewayhewastrained20or
30 years ago you will hate this book; if you are being trained by
suchasurgeonthenyoudesperatelyneedtoreadthisbook.
Dr. Anton Chekhov said: “Doctors are just the same as lawyers; the
onlydifferenceisthat lawyersmerelyrobyou,whereas doctorsrobyou
andkillyou, too.”Ourchiefaiminwritingthisbook wastohelpyounot
killyourpatients.Thisnon-orthodoxbookisnotyetanothertedious,fullof-detailstextbook.Wedonotneedmoreofthese.It’saimedatyou,the
youngpracticingsurgeonwhodesiresafocusedandfriendlyapproachto
emergency abdominal surgery. We hope and believe that this modest
bookwillbeofsomevaluetoyou.
AndréMauroissaid:“Inliterature,asinlove,weareastonishedatwhat
ischosenbyothers.”Wehopeyouchosethisbook.
TheEditors
NorthernWisconsin/Glasgow/Helsinki/TelAviv/Baltimore
Reviewsofpreviouseditions
“This is written with short punchy chapters making it a very difficult
booktoputdown…”.
R.A.B.Wood
JournaloftheRoyalCollegeofSurgeonsofEdinburgh
“Since Mondor’stimes inthe forties of the lastcentury there was no
otherbookinsurgerytobewrittensoeasyandwitty…”.
BorisD.Savchuk
WorldJournalofSurgery
“By the end I was a total enthusiast… this is a text like no other I
read…Unreservedlyrecommendedtooldandyoungandalike.”
M.Winslet,RoyalFreeHospital,London
ColorectalDisease
“Thetitledescribesthisbookperfectly.Thisisano-nonsenseapproach
to the sometimes very difficult situations in general surgery.… The
authorsdescribetheirexperiences intoughsituationsof patientcarefor
residents and young attendings.… the historical quotes add a good
amountofinsightandinterest.Ihavenotcomeacrossanotherbooklike
this.… Focused on the real situations that surgeons come across, the
book answers the questions that are not addressed in the major
textbooks.”
RobertA.Hanfland
Doody’sReviewService
“This book covers emergency abdominal surgery in a useful and
interestingway.[Itis]asmallandhandybookyetthecoverageiswide.It
wouldbeofinteresttoanygeneralsurgeonandshouldcertainlyberead
by surgical trainees. [It] allows mention of many things which would
otherwise be excluded from a more rigidly structured work. I was also
gladtoberemindedofmanythingswhichIhadknownbutforgotten.The
writersclearlyknowwhattheyaretalkingabout.”
DavidEvans
AnnalsoftheRoyalCollegeofSurgeonsofEngland
Asampleoftestimonialspostedonamazon...
ByDonaldDupuis,MD,LaheyClinic
“A Must Have Book. I am about to end my chief year in
generalsurgeryresidency—mycopyofthefirsteditionshowsthewear
of half a dozen total read throughs and probably hundreds of
referencings.Newesteditionisequallygood.Forthelast3yearsIhave
giventhis booktoour internsif theyfinishtheir surgicalinternship.And
I’vepaid for thismyself— if you knowhow little residentsgetpaid you
willknowhowimportantIthinkitis.IfyouareinsurgicaltrainingDONOT
WAITANOTHERDAYBEFOREYOUBUYTHISBOOK.Idoagreewith
anotherreviewerwhothoughtabitofcoolsurgicaltechniquewouldhave
beengoodtoo.But,allinall,best,mostusefullittlebookonsurgeryever.
Nuffsaid.”
ByChetA.Morrison,AssistantProfessorofSurgery,DirectorofSurgicalCriticalCare,
MichiganStateUniversity
“A very useful practical guide. This is a fine book in the
tradition of ‘guides to being on call’ — or maybe the ‘guide to the
perplexed’. I like the straightforward get to the point style, and the
directness of the book makes this a useful book to have handy when
confrontedwith some of the emergencysurgeryproblems. I would only
sayit could havehad a bitmore on surgicaltechnique,and oneortwo
referenceswould havebeenuseful (insteadthere was almosta militant
insistence on as few as possible). But I would recommend it for any
residentwhoisoncall,andIfinditusefulasastaffsugeonaswell.”
ByK.M.Kemp
“Love it. I’m a big fan of this book, having just finished it a
month ago. It’s a good mix of the author’s own experience as well as
expert commentary when indicated.Compared to a textbook,it’s much
more engaging and easier to read. Also compared to a text, it seems
much more practical in the advice it gives. As a brand new intern, I
gleanedalotfromthisbook.Highlyrecommendedforfellowtrainees.”
ByJendri
“Asurgical must have. This is a very well written and very
practical guide to emergency surgery. It covers virtually all aspects of
emergencygeneralsurgeryanddoesitinaveryinterestingway.I think
thisisoneofthebestbooksonthesubject.Formeitcertainlyisamust
have.Inthenextedition,probablytheonlythingthatIwouldliketoadd
tothisbookwouldbetheinformationaboutthemilitaryuniformwornby
Dr.KarlScheinonthephotographononeofthefirstpages.Dr.Scheinis
wearingauniformofthe1stPolishArmyformedinSovietUnionin1943.
Altogetheragreatbook.”
Byandreromeo
“Amust. Dr. Moshe Schein has a very personal view about
medicineandabouttheartofsurgery,andthatiswhythisbookisreallya
mustforcliniciansandsurgeons.”
ByAndy
“Simply perfect. The best choice in surgery for trainees! It
makes the more difficult surgery areas very easy to understand. I
recommendittoallsurgeons.”
Bymaxim
“Worth every penny. Invaluable as a guide to assist in the
resolution of a broad range of abdominal problems. The book is well
structured, running from opening chapters addressing pre-operative
issues, and on through a pretty complete spectrum of gut complaints
likelytoariseintherealworld,andhowbesttosortthemout.It’snotonly
useful,butverywellwritten,and,foratextbook,anabsolutepleasureto
read. Short bite size chapters combined with the occasional cartoon
make this 3rd edition of Schein well worth the investment. Blend with
Cope’sDiagnosisoftheAcuteAbdomenfortheidealcocktail.”
ByJ.D.Wassner
“Well-written, easy to read. Should be required reading for
anygeneralsurgeryresident,&anyonewhodoesacutecare&trauma.”
PARTI
Generalconsiderations
Chapter1
Generalphilosophy
MosheSchein,PaulN.Rogers,AriLeppäniemi,DannyRosinand
JonathanE.Efron
Wisdomcomesalonethroughsuffering.
Aeschylus,Agamemnon
Goodjudgmentcomesfromexperience,experiencecomes
frombadjudgment.
Surgeonsareinternistswhooperate…
Atthis moment —just as youpick up thisbookand begintobrowse
throughits pages— thereare manythousandsofsurgeonsaroundthe
world facing a patient with an abdominal catastrophe. The platform on
whichsuchanencounteroccursdiffersfromplacetoplace—amodern
emergencydepartmentinLondon,ashabbycasualtyroomintheBronx,
or a doctor’stent in the African bush.But the scene itselfis amazingly
uniform.Itisalwaysthesame—youconfrontingapatient,hesuffering,
in pain, and anxious. And you are anxious as well: anxious about the
diagnosis, concerned about choosing the best management, troubled
aboutyourownabilitiestodowhatiscorrect.
Weareinthe21stcenturybutthis universalscenarioisnotnew.Itis
asoldassurgeryitself.Youareperhapstooyoungtoknowhowlittle
some things havechanged — orhow other things have changed,
andnotalwaysforthebetter—overtheyears.Yes,yourhospitalmay
beintheforefrontofmodernmedicine;ithasateamofsubspecialistson
call to provide advice (it has an even larger administrative team of
functionariesto monitoryou…), itsemergency roomhas standby,stateof-the-artspiralcomputedtomographyandmagneticresonanceimaging
machines,but,practically,somethinghasnotchanged:itisthepatient
andyou(oftenwiththeentire‘system’againstyou)—youwhoare
duty bound to provideacorrect management planand executeit.
And it often feels lonelyout there;even we,experienced old farts,can
feeltheloneliness.
The‘best’managementofanabdominalemergency
Itisusefultocomparetheemergencyabdominalsurgeontoaninfantry
soldier( Figure 1.1). Awayfrom the limelight and glory that surrounds
cardiacorneurologicalsurgeons,emergencyabdominalsurgeryiscloser
toinfantrythanitistoairborneaction.Awarcannotbewonbyremote
control with cruise missiles, or robots, but with infantry on the
ground. Likewise, technological gimmicks have a limited place in
emergency abdominal surgery, which is the domain of the surgeon’s
brain and hands. To achieve the final ‘victory’ someone has to
agonize,sweat,bleed,andwethishands—rememberthebadsmell
from your hands after operating on a perforated colon? Some
readers may struggle with this military metaphor but the truth of the
matter is that emergencyabdominal surgery shares afew simple rules
withinfantryaction—developedinthetrenchesandduringoffensives—
rulesthatarethekeytosurvivalandvictory( Table1.1).Suchacodeof
battleechoesthe‘best’managementofabdominalemergencies.
Figure1.1.“Thinkasaninfantrysoldier...”
Therearemanywaystoskinacatandyouknowfromyourvarious
surgical mentors thatdifferentclinical pathways mayarrive at a similar
outcome.However,oneofthediversepathwaysisthe‘best’—thus,the
‘correct’one!
Tobeconsideredassuch,thepreferredpathwayhastosavelife
and decrease morbidity in the most efficient way. Look at the
followingexample.
You can manage perforated acute appendicitis using two different
pathways( Chapter 23) — both leading to aneventual recovery and
bothconsideredabsolutelyappropriate( Table1.2).
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