Surgical emergencies: diagnosis and minimally invasive treatment
Sudden abdominal pain, bowel obstruction, appendicitis, cholecystitis, a strangulated hernia or a perforation may require prompt surgical assessment. In many selected cases, even an emergency operation can be performed with a laparoscopic or minimally invasive technique.
ContactSurgical emergencies include very different conditions that share the need to establish quickly:
- 01
the diagnosis
- 02
the severity of the condition
- 03
whether or not surgery is needed
- 04
the most appropriate time to operate
- 05
the safest surgical technique
Not every abdominal pain requires surgery, and not every emergency needs the same strategy.
In emergency surgery the priority is to treat the cause of the problem quickly and safely. When the clinical and anatomical picture allows, this can also be done through a minimally invasive approach.
What are the most common surgical emergencies?
Conditions that most often require urgent surgical assessment include:
- Acute appendicitisGo to section
- Acute cholecystitisGo to section
- Bowel obstructionGo to section
- Incarcerated or strangulated herniaGo to section
- Gastrointestinal perforationGo to section
- Complicated diverticulitisGo to section
- PeritonitisGo to section
- Intestinal ischaemiaGo to section
- Some postoperative complications
- Other causes of acute abdomen
Acute appendicitis
Appendicitis is one of the most common causes of a surgical acute abdomen.
Inflammation of the appendix may begin with non-specific abdominal pain, which then most often localises to the lower right side of the abdomen.
It may be accompanied by:
- nausea
- vomiting
- fever
- loss of appetite
- tenderness on palpation
- progressive worsening of symptoms
Laparoscopic appendicectomy
When surgery is indicated, the appendix can generally be removed by laparoscopic appendicectomy, through small abdominal access points.
Laparoscopy also allows the abdominal cavity to be explored directly and any other causes of pain to be checked.
Acute cholecystitis
Acute cholecystitis is inflammation of the gallbladder, frequently associated with gallstones.
It may cause:
- pain in the upper right abdomen
- nausea or vomiting
- fever
- pain after meals
- abnormal blood tests
When surgery is indicated, treatment consists of removing the gallbladder.
Laparoscopic or robotic cholecystectomy
Laparoscopic cholecystectomy is one of the most frequently used minimally invasive procedures, including in the emergency setting.
The timing of surgery is decided on the basis of the clinical picture, test results and the patient's condition.
Bowel obstruction
Bowel obstruction is the arrest of, or severe difficulty in, intestinal transit.
It may be caused by:
- adhesions from previous surgery
- hernias
- tumours
- strictures
- volvulus
- other intestinal conditions
Symptoms may include:
- abdominal pain
- marked distension
- nausea and vomiting
- inability to pass stools
- inability to pass wind
Minimally invasive treatment of obstruction
An experienced surgeon and team can also treat bowel obstruction with a minimally invasive approach:
- 1adhesiolysis
- 2reduction of volvulus
- 3bowel resections
- 4repair of strangulated hernias
Incarcerated and strangulated hernia
A hernia can become an emergency when its contents become trapped and can no longer return spontaneously.
Incarcerated hernia
Strangulated hernia
It may present with:
- sudden, persistent pain
- increased tension of the hernia
- nausea or vomiting
- symptoms of bowel obstruction
- deterioration in general condition
Bowel strangulation is a time-dependent condition and requires urgent surgical assessment.
Minimally invasive hernia surgery, even in an emergency
In selected patients, some complicated hernias can be treated with a laparoscopic or minimally invasive approach.
The choice depends on:
- 1type and site of the hernia
- 2viability of the bowel
- 3presence of obstruction
- 4any abdominal contamination
- 5the patient's general condition
Gastrointestinal perforation
Perforation of the stomach or bowel creates a communication between the digestive lumen and the abdominal cavity.
Gastrointestinal contents may spread into the abdomen and cause:
- inflammation
- peritonitis
- infection
- sepsis
It may be associated with sudden, severe pain and requires prompt assessment.
Can laparoscopy be used?
In some stable patients and under certain anatomical conditions, even a perforation can be managed with laparoscopic surgery.
In more advanced cases or in the presence of instability, an open (laparotomic) approach may instead be required.
Complicated diverticulitis
Diverticulitis does not always require surgery.
Some forms may, however, be complicated by:
- abscess
- fistula
- stricture
- obstruction
- perforation
- peritonitis
Depending on the situation, treatment may include:
- medical therapy
- radiological procedures
- drainage
- surgery
When a colon resection is needed, the approach can be minimally invasive in selected patients.
Learn more about colon diseasesPeritonitis
Peritonitis is inflammation of the lining of the abdominal cavity and may result from several surgical conditions, including:
- bowel perforation
- complicated appendicitis
- perforated diverticulitis
- intestinal ischaemia
- postoperative complications
Severity can vary widely.
When there is a surgical source, the aim of the operation is to rapidly control the cause of abdominal contamination.
Depending on the cause, it can also be treated with minimally invasive techniques.
Intestinal ischaemia
Intestinal ischaemia occurs when part of the bowel receives an insufficient blood supply.
If the blood supply is not restored, the tissue may undergo necrosis.
Assessment must be rapid and may require:
- blood tests
- contrast-enhanced CT
- interventional radiology assessment
- surgery
The strategy depends on the cause, the site and the viability of the bowel.
Minimally invasive surgery, even in an emergency
An emergency operation does not necessarily mean an "open" operation.
Minimally invasive surgery can also be used in emergency surgery for many abdominal conditions.
Through small access points it is possible to:
- 1explore the abdominal cavity
- 2identify the cause of the acute abdomen
- 3treat the condition
- 4assess bowel viability
- 5perform resections or repairs when indicated
Emergencies that can be treated laparoscopically in selected patients include:
- appendicitis
- cholecystitis
- some bowel obstructions
- incarcerated or strangulated hernias
- some perforations
- complicated diverticulitis
- some postoperative complications
What are the possible advantages of minimally invasive emergency surgery?
faster postoperative recovery
less trauma to the abdominal wall
exploration of the entire abdominal cavity
reduced impact on the surgical wound
early mobilisation
lower risk of wound infection
smaller incisions
The possibility of using minimally invasive surgery must never take precedence over safety: the approach is chosen according to the severity of the emergency and the patient's condition.
Robotic surgery in emergencies
Robotic surgery can also be used in some selected emergency scenarios.
The robotic system is fully controlled by the surgeon and offers:
- three-dimensional vision
- articulated instruments
- precision of movement
- the ability to perform complex procedures through minimally invasive access
However, in an emergency, use of the robotic platform must be compatible with:
- the patient's clinical condition
- the type of condition
- the time required
- availability of the technology
- operating theatre organisation
Robotics must never delay the treatment of a surgical emergency.
How is a surgical emergency assessed?
Surgical examination
It allows assessment of symptoms, the abdomen, clinical parameters and the patient's history.
Blood tests
Ultrasound
Contrast-enhanced abdominal CT
When should you seek urgent medical attention?
Prompt assessment is needed in the presence of symptoms such as:
- severe or worsening abdominal pain
- a very distended abdomen
- persistent vomiting
- inability to pass stools or wind
- high fever with abdominal pain
- a hernia that suddenly becomes painful and tense
- significant bleeding
- rapid deterioration in general condition
If symptoms are severe
Do not wait for a routine outpatient appointment.
After emergency surgery
Even after an emergency procedure, when conditions allow, the postoperative pathway may include:
early mobilisation
multimodal pain control
gradual resumption of eating
clinical monitoring
prevention of complications
gradual return to normal activities
Recovery depends mainly on the condition treated, its initial severity and the type of operation.
Frequently asked questions
The most common include appendicitis, acute cholecystitis, bowel obstruction, incarcerated or strangulated hernia, gastrointestinal perforation and complicated diverticulitis.
Yes. Many abdominal emergencies can be treated laparoscopically in selected patients, when clinical and anatomical conditions allow.
Yes. Appendicectomy can be performed laparoscopically in many patients.
Yes. When surgery is indicated, cholecystectomy can be performed with a laparoscopic approach in many patients.
Strangulation can compromise the blood supply to the contents of the hernia and requires urgent surgical assessment.
In some selected cases, yes, provided its use does not delay the necessary treatment.
Very severe or worsening pain, persistent vomiting, marked abdominal distension, significant bleeding, a serious general deterioration or other major acute symptoms require urgent assessment.