Emergency Abdominal Surgery in Infancy, Childhood and Adult Life
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* Steven Paraskevas

**EMERGENCY ABDOMINAL SURGERY IN INFANCY, CHILDHOOD AND ADULT LIFE.** 3rd edition. Edited by Peter F. Jones, Zygmunt H. Krukowski and George G. Youngson. 556 pp. Illust. Chapman & Hall Medical, London, UK; Edward Arnold (Publishers) Ltd., London, UK. 1998. £45. ISBN 0-412-81950-3

As the editors note in their introduction, emergency laparotomy is a familiar and unsettling procedure for the general surgeon and is the “heart and soul” of general surgical training and practice. Despite this, few texts deal specifically with the evaluation and treatment of the acute abdomen. The editors have produced here a volume that should be valuable not only for residents in training or preparing for fellowship examinations but also for practitioners seeking an up-to-date reference.

This is primarily a clinical text and tends to avoid extensive descriptions of disease pathophysiology. Each section begins with a short overview, describing the evolution of present-day management. The sections dealing with preoperative work-up, diagnosis and management are particularly well written. There is a clear bias toward the importance of good history-taking and physical examination, and the attention to detail in this book will surprise anyone accustomed to reading the standard general surgical texts. Operative management is described clearly and in detail, and in most cases multiple operative approaches, their risks and benefits are discussed and compared. Rare and unexpected findings are discussed thoroughly, with appropriate reference to published series.

In addition to chapters on acute appendicitis, and upper and lower gastrointestinal disease, there are notable chapters on emergency pediatric abdominal surgery, pancreatobiliary disease, abdominal trauma, acute abdomen in pregnancy, urologic and gynecologic disease and vascular emergencies. There is also a thorough section on medical aspects of the acute abdomen, which gives an exhaustive description of nonsurgical conditions presenting with acute abdominal pain and how to eliminate them. Local and regional anesthesia and postoperative pain management are also covered.

Combined with exceptional writing, the book’s strengths include numerous references and an evidence-based approach that is taken to underscore almost every item discussed, making for an up-to-date review of the subject.

Perhaps the only shortcoming is the illustrations, of which there are only 94 and which are exclusively line drawings. The chapter on pancreatobiliary disease, for example, has only a single figure, and the chapter on vascular emergencies has none. Also, the book contains only a few tables to present data in a more organized fashion. Those readers accustomed to the highly illustrated American texts and those looking for “quick-fix” lists to commit to memory may be disappointed with this book. But anyone willing to sit down with the book will find that its eloquence and thoroughness more than compensate for the lack of visual impact. By focussing on the clinical evaluation and management of the acute abdominal crisis, this book retains its high level of utility, particularly for the surgical trainee. In most texts, these topics tend to be dispersed among details of physiology, pathology and elective management. This book goes into far greater depth without becoming ponderous. As a practical guide to the problems most demanding of the general surgeon’s expertise, it is a valuable addition to any library.