Correct!
5. All of the above
The first decision to be made in the management of air in the bowel wall is a judgment of the likelihood of an intra-abdominal catastrophe (2). A history of vascular disease, physical signs of an acute abdomen, metabolic acidosis, elevated lactate, elevated amylase or the presence of air in the portal vein all make an intra-abdominal catastrophe more likely. Emergent surgical exploration is indicated for patients with a suspected acute abdominal event.
If a patient is asymptomatic and an intra-abdominal catastrophe is not clinically suspected, observation is appropriate. Antibiotics, hyperbaric oxygen, and an elemental diet are appropriate for patients with mild-moderate clinical severity but without suspicion of a catastrophic event. Palliation may be appropriate for patients who are nor surgical candidates.
Surgical consultation was obtained in our patient, and although they agreed a surgical intra-abdominal catastrophe was likely, the surgeons felt the patient was not a surgical candidate because of his advanced age and a multitude of underlying diseases. After consultation with the patient’s family, palliative care was instituted and the patient died peacefully.
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