Acute Abdomen, Bowel Perforation, Intestinal Obstruction and Peritonitis — WACS Viva & Clinical Scenarios (General Surgery)

Exam-style acute abdomen, bowel perforation, intestinal obstruction and peritonitis viva scenarios with examiner probes and model answers for ANAESTHESIA…

Scenarios covered

• SCENARIO 1: A 24-year-old male with a 10-day history of high-grade fever presents with sudden worsening of diffuse abdominal pain, rigidity, and feculent vomiting of 36 hours duration. He is diagnosed with typhoid ileal perforation. On examination, blood pressure is 80/45 mmHg, pulse rate 138 beats per minute weak and thready, respiratory rate 34 breaths per minute, SpO2 92% on room air, cold peripheries, and urine output of 10 mL/hr. Outline your perioperative anaesthetic management for an emergency exploratory laparotomy.
• SCENARIO 2: A 68-year-old female presents with a 4-day history of progressive abdominal distension, absolute constipation, and vomiting. Abdominal radiography reveals a classic coffee-bean sign diagnostic of sigmoid volvulus. Blood pressure is 95/60 mmHg, heart rate 118 beats per minute irregular, serum potassium is 2.8 mmol/L, sodium is 126 mmol/L, and urea is 18 mmol/L. Discuss your preoperative optimization and anaesthetic induction strategy.
• SCENARIO 3: A 45-year-old male presents with severe epigastric pain following long-term non-steroidal anti-inflammatory drug (NSAID) usage. Erect chest radiograph reveals free gas under the right hemidiaphragm. Arterial blood gas on room air shows pH 7.26, PaO2 72 mmHg, PaCO2 31 mmHg, Base Excess -8 mmol/L, and Lactate 4.2 mmol/L. Detail your intraoperative ventilatory and haemodynamic management plan.
• SCENARIO 4: A 32-year-old woman at 5 days post-caesarean delivery develops abdominal distension, high-spiking pyrexia, peritonism, and purulent wound discharge. Bedside ultrasound confirms extensive intra-abdominal collections with suspected bowel injury. Blood pressure is 85/50 mmHg on norepinephrine infusion at 0.15 mcg/kg/min. Describe your anaesthetic plan and safe management during emergency re-laparotomy.