Surgical Digestive Pathology: Acute Appendicitis, Peritonitis, Bowel Obstruction, Caustic Ingestion, and Abdominal Trauma

Essential vocabulary flashcards covering acute appendicitis, generalized peritonitis, acute intestinal obstruction, caustic ingestion, and abdominal trauma from surgical digestive pathology.

Appendicular Stercolith (Fecalith)

A hardened, calcified mass of fecal matter that occludes the narrow appendiceal lumen, triggering luminal stasis, rapid bacterial proliferation, and acute transmural inflammation.

Suppurative (Phlegmonous) Appendicitis

An anatomopathological stage of acute appendicitis where the appendix is swollen, covered with purulent false membranes, and exhibits multiple intramural micro-abscesses.

Gangrenous Appendicitis

An advanced macroscopic stage of acute appendicitis marked by greenish-black, necrotic tissue sloughing (sphacelus) along the appendiceal wall with imminent risk of perforation.

Appendicular Plastron (Phlegmon)

An inflammatory protective mass formed by the agglutination of the greater omentum and adjacent small bowel loops around an inflamed appendix to wall off and contain the infection.

Blumberg Sign

Sharp, severe pain elicited upon sudden decompression (release) of deep manual palpation in the right iliac fossa, indicating localized parietal peritoneal inflammation.

Rovsing Sign

Pain experienced in the right iliac fossa upon sudden or deep manual compression of the left iliac fossa due to displacement of intraluminal gas irritating the inflamed cecal region.

McBurney Incision

A standard open appendectomy incision placed obliquely in the right iliac fossa at McBurney point, located between the outer one-third and inner two-thirds of the line connecting the anterior superior iliac spine to the umbilicus.

Rockey-Davis Incision

A horizontal, transverse surgical incision made in the right lower abdominal quadrant that provides an aesthetically favorable scar for open appendectomy.

Jalaguier Approach

A vertical, pararectal incision along the lateral border of the rectus abdominis muscle, particularly useful when diagnostic certainty is lacking because it can be extended up or down.

Generalized Acute Peritonitis

A life-threatening medico-surgical emergency defined as acute, widespread inflammation of the entire peritoneal serosa secondary to chemical irritation or bacterial contamination from an intra-abdominal organ.

Abdominal Board-Like Rigidity ("Ventre de bois")

An involuntary, permanent, and painful contracture of the abdominal wall muscles triggered by severe parietal peritoneal irritation, characteristic of generalized peritonitis.

Douglas Cry ("Cri du Douglas")

Acute, excruciating pain elicited during a digital rectal examination when the examiner's finger presses upward against an inflamed, fluid-filled rectovesical or rectouterine pouch (cul-de-sac of Douglas).

Pneumoperitoneum

The presence of free extraluminal gas within the peritoneal cavity caused by a perforated hollow viscus, appearing on an upright chest X-ray as a radiolucent subdiaphragmatic crescent.

Diaphragmatic Peritoneal Pump

The upward aspiration of intraperitoneal fluid toward the subdiaphragmatic lymphatic spaces driven by the negative pressure generated during respiratory excursion of the diaphragm.

Two-Stage Peritonitis (Péritonite en 2 temps)

An evolutionary pattern of peritonitis in which an initially localized collection or phlegmonous focus (such as an appendiceal abscess) secondarily ruptures into the free peritoneal cavity.

Postoperative Anastomotic Leak Peritonitis

A severe form of peritonitis arising from the disruption of a surgical anastomosis (characteristically between day $5$ and day $7$), associated with an insidious presentation, septic shock, and a mortality rate exceeding $40\%$.

Epiplooplasty (Omental Patching)

A surgical technique in which a pedicled segment of greater omentum is placed and secured over a sutured visceral perforation (such as a duodenal or gastric ulcer) to ensure a watertight seal.

Mechanical Strangulation Obstruction

A bowel obstruction mechanism involving both mechanical occlusion of the intestinal lumen and immediate compromise of the mesenteric vasculature, leading rapidly to transmural infarction within $< 8\,\text{hours}$.

Mechanical Intraluminal Obstruction

Intestinal transit blockage caused by a foreign body, gallstone, or bezoar entirely lodged within the bowel lumen without primary compromise of parietal mesenteric blood supply.

Intestinal Intussusception (Invagination)

The telescoping of a proximal segment of intestine into an immediately adjacent distal segment, drawing its mesentery and blood supply inward to produce mechanical occlusion and progressive ischemic suffering.

Strangulated Hernia

The acute constriction and irreducible entrapment of a bowel loop through a congenital or acquired defect in the abdominal wall, compressing both luminal passage and mesenteric blood flow.

Postoperative Adhesions (Brides)

Acquired fibrous connective tissue bands resulting from prior abdominal surgery that kink, compress, or trap bowel segments, representing the leading etiology of small bowel obstruction.

Hydro-Aerial Levels (Niveaux Hydro-Aériques)

Characteristic radiographic signs on upright abdominal X-ray consisting of horizontal liquid interfaces crowned by gas caps in dilated intestinal segments located upstream of an obstruction.

Valvulae Conniventes Pattern

The radiographic appearance of small bowel obstruction showing multiple, central, thin air-fluid levels that are wider than they are high and contain mucosal circular folds traversing the entire luminal diameter.

Colonic Haustrations Pattern

The radiographic appearance of colonic obstruction characterized by few, peripheral, voluminous air-fluid levels that are taller than they are wide, separated by thick, incomplete transverse indentations.

Sigmoid Volvulus

Torsion of an abnormally elongated sigmoid colon (dolichosigmoid) around its mesenteric axis, causing simultaneous closed-loop bowel obstruction and progressive strangulation ischemia.

Hartmann Procedure

An emergency colonic operation consisting of the resection of the diseased bowel segment, closure of the distal rectal stump, and exteriorization of the proximal viable colon as an end colostomy.

Ogilvie Syndrome

Acute non-mechanical colonic pseudo-obstruction characterized by massive, rapid dilatation of the colon without a demonstrable anatomical obstacle, typically observed in elderly, bedridden, or severely ill medical patients.

Liquefactive Necrosis (Alkali Ingestion)

Deep, penetrating chemical burn pathology caused by strong alkalis ($\text{pH} > 12$) through lipid saponification, protein solubilization, and vascular thrombosis, predominantly affecting the esophagus.

Coagulation Necrosis (Acid Ingestion)

Chemical tissue injury produced by strong acids ($\text{pH} < 1$) characterized by protein denaturation that forms a firm, protective surface coagulum/eschar, typically concentrating severe damage on the gastric wall.

Debridement Phase (Caustic Ingestion)

The intermediate pathophysiological phase occurring between day $4$ and day $14$ ($J_4 - J_{14}$) following caustic ingestion, during which necrotic sloughing leaves the visceral wall at maximal fragility and highest risk of secondary perforation.

Chirica CT Classification

A computed tomography staging system for acute caustic injuries of the upper digestive tract based on the degree of wall thickening, fat stranding, and parietal contrast enhancement, identifying transmural necrosis at Stage $3$.

Zargar Endoscopic Classification

An upper gastrointestinal endoscopic grading scale used to evaluate mucosal caustic damage, ranging from superficial erythema (Stage I) to focal necrosis (Stage IIIa), extensive necrosis (Stage IIIb), and perforation (Stage IV).

Esophageal Stripping (Oesophagectomie à thorax fermé)

A closed-chest surgical procedure performed in severe transmural necrosis where the entire thoracic esophagus is bluntly dissected and pulled out from combined cervical and transhiatal abdominal routes without a formal thoracotomy.

Lethal Triad (Triade fatale)

A self-perpetuating physiological state of hypothermia, metabolic acidosis, and coagulopathy triggered by severe hemorrhagic shock and massive resuscitation in major trauma patients.

Damage Control Laparotomy (Laparotomie écourtée)

An abbreviated surgical procedure prioritizing rapid intra-abdominal hemostasis (packing, vessel ligation) and contamination control over definitive reconstructions, allowing the patient to be stabilized in the ICU before reintervention.

Focused Assessment with Sonography for Trauma (FAST)

A rapid, non-invasive bedside ultrasound examination dedicated to detecting free fluid (hemoperitoneum, hemothorax, or pericardial effusion) in dependent anatomical recesses following blunt or penetrating trauma.

Non-Operative Management (TNO)

A conservative management protocol implemented in approximately $85\%$ of blunt abdominal trauma patients who maintain hemodynamic stability without signs of hollow organ perforation, relying on close clinical, biological, and CT surveillance.

Diagnostic Peritoneal Lavage (PLP)

An invasive diagnostic procedure used when imaging is inaccessible; it is deemed positive if initial aspiration extracts $5\,\text{mL}$ of gross blood, red blood cell count exceeds $100\,000/\text{mm}^3$, or white blood cell count exceeds $500/\text{mm}^3$.