What diagnoses in the emergency department often require collaboration between internal medicine and surgery?

From the Guidelines

Emergency department diagnoses that frequently require collaboration between internal medicine and surgery include acute abdomen conditions, trauma cases, gastrointestinal bleeding, diabetic infections, vascular emergencies, and complicated infections. These conditions often present with complex pathophysiology affecting multiple organ systems, requiring both medical optimization and potential surgical intervention for optimal patient outcomes. Some specific examples of diagnoses that may require collaboration include:

• Acute abdomen conditions such as appendicitis, cholecystitis, bowel obstruction, and perforated viscus 1
• Trauma cases with both internal injuries and surgical wounds, particularly in patients with pre-existing medical conditions
• Gastrointestinal bleeding, where internists manage coagulopathies and hemodynamic stability while surgeons address potential surgical interventions 1
• Diabetic patients with infections like necrotizing fasciitis or diabetic foot ulcers, who benefit from surgical debridement alongside medical management of their diabetes and infection
• Vascular emergencies such as mesenteric ischemia, aortic dissection, and ruptured aneurysms, which require both specialties to manage cardiovascular stability and perform necessary interventions 1
• Complicated infections including intra-abdominal abscesses, which often need both antibiotic therapy and surgical drainage The most recent and highest quality study, published in 2023, emphasizes the importance of a multidisciplinary approach in managing emergency laparotomy, highlighting the need for collaboration between internal medicine and surgery to improve patient outcomes 1.

From the Research

Diagnoses Requiring Collaboration

Diagnoses in the emergency department that often require collaboration between internal medicine and surgery include:

• Acute appendicitis 2, 3, 4, 5
• Acute cholecystitis 2, 3, 5
• Sigmoid diverticulitis 2, 3, 5, 6
• Complicated intra-abdominal infection 2
• Perforated peptic ulcer disease 3
• Small bowel obstruction 3
• Incarcerated or strangulated inguinal hernia 3
• Intestinal malrotation 4

Surgical Conditions

Surgical conditions that may require collaboration between internal medicine and surgery include:

• Appendicitis with congenital gastrointestinal malrotation 4
• Cholecystitis with perforation 2
• Sigmoid diverticulitis with abscess or perforation 6
• Bowel perforation 2

Treatment Approaches

Treatment approaches for these diagnoses may involve:

• Empirical antibiotic therapy with ceftriaxone and metronidazole 2
• Laparoscopic surgery 3, 4
• Open surgery 6
• Conservative treatment for early stages of disease 5