General surgical and emergency surgery

Appendicitis is inflammation of the appendix, a small tubular structure found in the first part of the large intestine. It is one of the commonest surgical emergencies. 

Typical symptoms of appendicitis are pain in the centre of the abdomen which migrates to the right lower abdomen. The pain might be associated with nausea, vomiting, loss of appetite and a fever. 

Often the diagnosis is made from the clinical picture and blood results. Ultrasound and CT scans may be required to exclude other conditions and confirm the diagnosis. 

I carry out laparoscopic appendicectomy, the 'keyhole' removal of the appendix, in an emergency setting. 

Diverticulitis is the inflammation of diverticulae which are small bulges that develop in the lining of the large intestine. 

Symptoms of diverticulitis include severe or persistent abdominal pain in the lower left side of the abdomen, a high temperature and loose stools. Diverticulitis is usually treated with antibiotics. If antibiotics do not settle the inflammation, or if there are complications from diverticulitis such as perforation (bursting), emergency surgery may be required. I provide surgery for complicated diverticulitis in an emergency setting.

Diverticular bleeding is usually painless and can be alarming in volume, but in most cases it settles spontaneously. If the bleeding persists, intervention, usually with the help of an interventional radiologist is required.

I manage patients with acute diverticular bleeding in the emergency setting. 

Haemorrhoids are lumps inside and around the anus. They are caused by chronic straining to pass hard stools. They may also cause bleeding during a bowel movement.

Haemorrhoids are very common with symptoms often disappearing on their own after a few days. When symptoms persist and medical remedies are ineffective, surgical options are available to treat them.

Sometimes bleeding from haemorrhoids may be profuse and significant. In these instances, and once other causes are excluded, emergency treatment such as banding or excision may be required. 

I offer surgical treatment of haemorrhoids in the emergency setting. 

Obstruction of the bowel may affect the small or the large bowel (intestine). 

Small bowel obstruction is when a portion of the small bowel becomes blocked. The commonest causes of small bowel obstruction are hernias or adhesions (scar tissue). The typical related symptoms are abdominal pain, vomiting, abdominal swelling and failure to pass gas or stool. Some patients settle with non-operative treatment, while others may require surgery. If left untreated it may lead to bowel perforation (bursting) which is life-threatening. 

I manage patients presenting with small bowel obstruction in the emergency setting. 

 Large bowel obstruction occurs when the large intestine becomes blocked. The commonest causes are a growth within the bowel or twisting (volvulus) of the bowel. Patients with large bowel obstruction may present as an emergency with symptoms that include abdominal pain, swelling and failure to pass gas or stool. If left untreated it may lead to bowel perforation (bursting) which is life-threatening. 

I manage patients presenting with large bowel obstruction in the emergency setting. 

I provide the following procedures for bowel obstruction and perforation

• Laparotomy for acute bowel obstruction or perforation
• Diagnostic laparoscopy
• Laparoscopic or open adhesiolysis (removal of scar tissue)

A pilonidal infection is infection that occurs within a pilonidal sinus, a small pit in the skin at the top of the buttocks where they divide (the natal cleft). 

When the pilonidal sinus becomes infected, it causes pain, redness, swelling and may produce pus. An abscess developing from an infected pilonidal sinus is called a pilonidal abscess. 

I offer treatment for pilonidal infection in the emergency setting. 

Perianal abscesses are boils which develop near the anus or perianal region. They appear as tender lumps near the anus which can burst and discharge pus. At least half of these result from an abnormal connection between the anal canal and the skin, known as a fistula-in-ano.

Perianal abscesses are treated with antibiotics and drainage. Since they are exquisitely tender, the procedure is usually only tolerated under general anaesthesia. 

In the emergency setting, I provide 

 examination under anaesthesia of the anorectum and drainage of perianal abscesses.