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Gastrointestinal emergencies, 3rd edition
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This monograph has been divided into three sections namely, ‘Approach to specific presentations’, ‘Complications of gastrointestinal procedures and therapy’, and ‘Specific conditions’.
The first section deals with the approach to specific presentations viz. dysphagia, vomiting, upper gastrointestinal bleeding, acute abdominal pain, jaundice, severe lower gastrointestinal haemorrhage an d diarrhoea; constipation, however, has been omitted. Table 1.1 on the aetiology of oropharyngeal dysphagia erroneously mentions the pharyngeal pouch (Zenker diverticulum) and cricopharyngeal bar under ‘surgical procedures’ to the oropharynx. Table 1.2 on the aetiology of oesophageal dysphagia does not mention corrosive oesophageal stricture and retrosternal goiter. The chapter on vomiting does not mention gastritis, one of the commonest causes in clinical practice as a cause (similarly, enterocolitis is missing from chapter 7, ‘Approach to diarrhea’). The important topic of acute abdominal pain has been devoted only six pages. Though Table 4.2 lists extra-abdominal causes of acute abdomen, the main text describes abdominal examination only and does not mention examination of chest (lungs and heart) and investigations making no mention of an ECG. Table 5.1 (differential diagnosis of jaundice) lists even rare disorders eg., Wegner granulomatosis, but does not mention common causes of neonatal jaundice viz. extrahepatic biliary atresia, neonatal hepatitis and choledochal cyst as the cause of jaundice in younger patients. In neoplasms, there is no mention of gall bladder cancer, the commonest biliary tract cancer.
Though the book is titled ‘Gastrointestinal Emergencies’, a major (almost one-third) chunk (section two) is devoted to complications, albeit mainly of endoscopic procedures both diagnostic viz. upper gastrointestinal endoscopy, colonoscopy, capsule endoscopy, ERCP (endoscopic retrograde cholangiopancreatography), endoscopic ultrasound, and therapeutic eg., percutaneous endoscopic gastrostomy, endoscopic variceal ligation, sclerotherapy and balloon tamponade, only two chapters viz. laparoscopic and bariatric surgery, respectively deal with complications of surgery. While uncommon procedures such as endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) are honoured with a full chapter, newer procedures such as per oral endoscopic myotomy (POEM) and transanal endoscopic microsurgery (TEMS) are missing. Similarly, while complications of liver biopsy are covered in a full, though small, chapter, percutaneous radiological interventions viz. percutaneous transhepatic cholangiography (PTC) and percutaneous transhepatic biliary drainage (PTBD) find no mention. A large chapter is devoted to complications of drugs used in gastroenterology.
The third section covers specific conditions ranging from oesophageal foreign bodies and perforation, non-variceal upper gastrointestinal and variceal haemorrhage, middle gastrointestinal bleeding, acute pancreatitis, biliary emergencies, acute liver failure, alcoholic hepatitis, gastrointestinal infections, ischaemic bowel, acute severe ulcerative colitis and diverticular disease. This section also covers gastrointestinal complications of HIV and in ICU. The chapter on biliary emergencies covers cholangitis but cholangiolytic abscess is not mentioned. Oesophageal foreign bodies are included but rectal foreign bodies are missing. Chapter 29 covers perforation (peritonitis) and chapter 27 describes spontaneous bacterial peritonitis but primary peritonitis and tertiary peritonitis are not covered.
While the book has several endoscopic images (in colour), many chapters could have been better illustrated with radiological images; chapters on dysphagia, acute abdominal pain, jaundice, biliary tract emergencies, perforation of gastrointestinal tract, intestinal obstruction, acute appendicitis, ischaemic bowel, acute severe ulcerative colitis and diverticular disease do not have a single radiological image. Further, paediatric gastrointestinal emergencies such as congenital hypertrophic pyloric stenosis (CHPS), Hirschsprung's disease and necrotizing enterocolitis (NEC) are missing.
The book also suffers from the usual maladies of a multi-editor multi-author monograph viz. non uniformity of chapters - chapter lengths vary from 4-15 pages, number of references ranging from as low as three (chapter 5 on jaundice) to as many as 112 (chapter 18 on bariatric surgery). Chapter 30 (on intestinal obstruction) has no references at all. While most chapters have references which are numbered and cited in the text, some chapters (eg., chapter 1 on dysphagia, chapter 2 on vomiting and chapter 36 on diverticular disease) have a list of further readings only with no citations in the text.
Overall, this book will be useful to gastroenterologists, endoscopists, surgeons, emergency and acute physicians but only as a basic guide in the primary years of their training. It is expected and hoped that the next (4th) edition will cover the above mentioned deficiencies and will thus become more useful.
