A 40-year-old man on ICU develops an acute abdomen. CT shows free intraperitoneal air consistent with a perforated viscus. He is on high-dose noradren...

Question

A 40-year-old man on ICU develops an acute abdomen. CT shows free intraperitoneal air consistent with a perforated viscus. He is on high-dose noradrenaline (0.6 mcg/kg/min) for septic shock. The surgical team is hesitant to operate due to haemodynamic instability. What is the correct approach?

Accepted Answer

Emergency surgery should proceed despite haemodynamic instability - source control is the priority, and delaying surgery to achieve haemodynamic stability in the setting of ongoing contamination will lead to further deterioration

Answer

Defer surgery until vasopressors are weaned completely

Answer

Conservative management with antibiotics and NG decompression only

Answer

Percutaneous drainage as definitive management

Answer

Commence TPN and avoid surgery

uk-fficm MCQ (SBA): Perforated Viscus - Source Control

A 40-year-old man on ICU develops an acute abdomen. CT shows free intraperitoneal air consistent with a perforated viscus. He is on high-dose noradrenaline (0.6 mcg/kg/min) for septic shock. The surgical team is hesitant to operate due to haemodynamic instability. What is the correct approach?