Emergency Surgery

Aside from serious injuries, many conditions can turn into life-threatening or urgent situations that need immediate surgery. Our nationally recognized emergency surgery team and multidisciplinary resources are available 24/7/365 to treat these conditions, leading to your best possible outcome.

The Froedtert & MCW adult Level I Trauma Center at Froedtert Hospital is verified by the American College of Surgeons (ACS) as an Emergency General Surgery Center and is recognized as an ACS Surgical Quality Partner for providing timely, expert care. 

Learn More

If you experience sudden, severe abdominal pain, fever, nausea or other concerning symptoms call 911 to get lifesaving emergency care immediately.

Common Conditions Leading to Emergency Surgery

The conditions that most often need emergency surgery are:

• Severe or unexplained abdominal pain
• Complications from acute or chronic gastrointestinal conditions
• Infections, abscesses and other complications related to surgery
• Other severe abdominal conditions with sudden onset (acute)

Many conditions can lead to the need for emergency surgery, including the following.

Appendicitis

When the appendix becomes inflamed, it is called appendicitis. It is the most common cause of sudden, severe pain within the belly.

Symptoms of Appendicitis

• Pain that starts around the belly button and moves to the lower right part of the abdomen. Pain gets worse over time. Coughing, walking or sudden movements can make the pain more intense.
• Nausea and vomiting: Often with the start of abdominal pain
• Fever — Can start as low-grade but increase if the appendix bursts
• Swelling in the abdomen
• Constipation or diarrhea
• Can’t pass gas

Appendicitis Treatment

A surgeon treats appendicitis by removing the appendix or sometimes, with antibiotics alone. 

If it’s not treated, appendicitis is a life-threatening infection that can spread throughout the belly. It often requires surgery to clean out the inside of the abdomen and to remove the appendix. A burst appendix can also lead to an abscess of the appendix, which is an infection that presents as a pocket filled with pus. A surgeon will remove the appendix and drain the abscess, allowing healing to take place.

Bowel Obstruction

Bowel obstruction means part or all of the small or large intestine becomes blocked. Around 80% of obstructions happen in the small intestine. 

Food, waste, gas and digestive juices are trapped in a section of the bowel. The obstruction may be strangulated. Strangulated means the obstruction is keeping part of the intestine from getting a blood supply. Gangrene can set in if tissues die, which can lead to infection or even death.

A non-strangulated bowel obstruction is still very serious. Both types can cause a hole or tear in the bowel (perforation), leading to infection and sepsis.

Bowel obstructions can happen for several reasons:

• Hernia
• An adhesion or scar from surgery or an infection
• Lower part of the intestine twists on itself
• Intussusception, when the bowel “telescopes” in on itself (usually in children younger than age three, but can happen in adults)
• Cancer — often before diagnosis, if tumors block the bowel

Symptoms of Bowel Obstruction

• Pain and cramping in the abdomen. It can come and go, or may be constant if the obstruction gets worse.
• Nausea and vomiting (in severe obstruction, vomit may contain fecal matter)
• Swollen belly from trapped gas and fluids
• Constipation
• Can’t pass gas (may still be able to if obstruction is partial)
• Diarrhea (partial obstruction)
• Fever
• Fast heart rate
• Low blood pressure

Treatment for Bowel Obstruction

If the obstruction is complete, it requires surgery immediately. The surgical team will remove the cause of the blockage, and if it is strangulated, may need to remove part of the bowel. If the obstruction is partial, depending on the cause, it may be possible to treat it with IV fluids, a nasogastric tube to remove backed up fluids and air (a thin tube through your nose into the stomach), anti-nausea and pain medications, and bowel rest to allow the intestines to clear the obstruction.

Diverticulitis 

Pouches or sacs of tissue (called diverticula) can push through weak spots in the colon wall. You may have diverticulosis, which causes few or no symptoms. However, when the pouches become infected or inflamed the condition is called diverticulitis. Pouches can form an abscess, or they can rupture. Diverticulitis usually causes severe abdominal pain but can cause other symptoms, too.

Symptoms of Diverticulitis

• Sharp, constant pain, typically in the lower left part of the abdomen
• Fever and chills
• Nausea and vomiting
• Constipation or diarrhea
• Bloating or gas
• A tender or sore abdomen
• No appetite

Treatment for Diverticulitis

Mild diverticulitis can be treated with a change in diet and pain management. If there are signs of complication such as abscess, perforation, peritonitis, fistula (abnormal path that opens between parts of the body that aren’t normally connected) or bowel obstruction, surgery, along with hospitalization and IV antibiotics may be needed. In some cases, an abscess can be drained with a needle using CT image guidance.

Gallbladder Disease

The gallbladder is a separate pouch under the liver that stores bile produced by the liver to help digest fat. The gallbladder can become inflamed or infected, causing a “gallbladder attack,” which is sudden, severe pain. This is often due to having gallstones but can also be caused by tumors in the gallbladder or bile ducts, tissue growths or abnormal emptying of the gallbladder.

Gallstones are hard little stones made of cholesterol or bilirubin (product of break-down of red blood cells). People who are overweight are more likely to develop gallstones. While males tend to get them after age 60, females are more susceptible to developing gallstones between ages 20 and 50.

Symptoms of Gallbladder Disease

• Pain in the right upper right part of the abdomen; it can radiate to the right shoulder or back. Pain can last 30 minutes to several hours. It may be particularly noticeable after a high-fat meal.
• Nausea and vomiting, with or without eating
• Fullness after eating
• Gas or belching
• Feeling full earlier than usual
• Fever and chills
• Jaundice (yellowing of eyes, skin)
• Stools the color of clay
• Dark urine
• Signs of sepsis — confusion, fast heart rate, low blood pressure

Treatment for Gallbladder Disease

• Surgery to remove the gallbladder is the preferred treatment for gallstones with symptoms, for an inflamed gallbladder, for a poorly functioning gallbladder and for a gallbladder attack. Treatment will also include IV antibiotics, fluids and pain control.
• Gallstones without symptoms can be treated with a low-fat diet and healthy weight management.
• Gallbladder disease caused by stones in the bile duct can be removed with surgery at the same time as gallbladder removal, or with endoscopic retrograde cholangiopancreatography (ERCP) followed by surgery to remove the gallbladder.

Hernia Complications

When a portion of intestine or fat is trapped inside a hernia sac, it is called incarcerated (hernia contents get stuck and can’t be pushed back in) or strangulated inguinal hernia (blood supply to the hernia tissue is cut off). 

A strangulated hernia can lead to gangrene within a few days if it’s not treated. Gangrene means the trapped tissue that doesn’t have a blood supply dies due to lack of blood flow. Bacteria from gangrenous tissue can spread throughout the body, leading to septic shock. 

Symptoms of Incarcerated Hernia

• Severe pain where the hernia is located
• Firm bulge that is sore to the touch and can’t be pushed in
• Nausea or vomiting
• Abdominal swelling
• Constipation or can’t pass gas
• edness or discoloration where the hernia is located

Symptoms of Strangulated Hernia

• Sudden, intense pain; pain that gets worse over time
• Fever
• Skin in the area where the hernia is located is red, purple or dark
• Fast heart rate
• Sepsis symptoms (confusion, low blood pressure, chills)
• Nausea/vomiting with bloating or a rigid-feeling abdomen

Treatment for Hernia Complications

• In most cases, if incarcerated or strangulated hernias are treated right away, the trapped portion of intestine does not die. Surgery, which may be open or minimally invasive (laparoscopic or robotic-assisted), releases the intestine, and the hernia is repaired in the same operation.
• If trapped intestinal tissue is gangrenous, surgery is more complicated. A surgeon removes dead tissue, reconnects the separated portions of intestine and repairs the hernia.

Pancreatitis

The pancreas is a gland that contributes to digestion by releasing digestive enzymes and helps control blood sugar by producing insulin and glucagon. When the pancreas becomes inflamed, it is called pancreatitis. The top causes of pancreatitis are gallstones or heavy alcohol consumption. It can also be related to having high triglycerides (a type of fat in the blood), taking some medications, autoimmune diseases or genetic conditions, pancreatic cancer or bile duct obstruction.

Pancreatitis can be chronic (you have the condition all the time) and managed with eating a low-fat diet, avoiding alcohol, quitting smoking, taking pancreatic enzymes and if you have diabetes, keeping it under control. If you have abdominal pain that flares up repeatedly, combined with weight loss, oily, bad-smelling stool or pancreatitis symptoms paired with diabetes, talk with your doctor about care.

It can also be acute (happening suddenly), which requires urgent treatment.

Symptoms of Acute Pancreatitis

• Sudden, severe pain in the upper part of the abdomen. Pain may spread to the back and may be worse after eating.
• Nausea and vomiting
• Fever
• Sore, swollen abdomen

Treatment for Acute Pancreatitis

Acute pancreatitis requires an emergency visit and a hospital stay to get the condition under control. You’ll receive IV fluids and pain control medication. You may have surgery to remove gallstones if stones are the cause of the condition.

Perforated Ulcer or Bowel

A perforation is a hole. It can develop in the stomach or duodenum (part of the small intestine) if you have an ulcer that breaks through the lining. A hole in the bowel can happen due to a traumatic injury, bowel obstruction, infection or a malignant tumor.

Perforated ulcers and bowel perforations cause serious bleeding and sudden, sharp pain in the abdomen. Perforations allow food, stool and bacteria to leak into the abdominal cavity, causing infection of the lining of the abdomen, a condition called peritonitis. If the bacteria enters the blood, it can lead to sepsis.

Symptoms of Perforated Ulcer

• Sudden, severe pain in the abdomen, which may feel sharp or stabbing. This pain is usually located in the upper abdomen but can spread. It may spread to the shoulders or back, as well.
• Abdomen feels stiff and is sore to the touch
• Nausea and vomiting
• Fever and chills
• Signs of infection or sepsis
• Fast heart rate and fast breathing
• Low blood pressure, dizziness or fainting

Symptoms of Perforated Bowel

• Sudden, severe pain in the abdomen, which may feel sharp or stabbing. This pain is usually located in the lower abdomen (if the large intestine has been perforated) but can spread.
• Abdomen feels stiff and is sore to the touch
• More pain when abdomen is pressed and released
• Nausea and vomiting — often early in the pain episode
• Fever and chills
• Swollen abdomen, feels bloated
• Fast heart rate and fast breathing
• Low blood pressure or dizziness

Treatment for Perforated Ulcer or Bowel

Both conditions are life-threatening and need immediate hospital admission and emergency surgery to repair the hole, stop leaking and prevent infection. Surgery may be open or minimally invasive (laparoscopic or robotic-assisted). Antibiotics are given to prevent or treat infection, and pain is controlled with medications.

If the bowel is perforated and part of it is damaged, part of the bowel will be removed. In certain situations, a colostomy or ileostomy may be needed. This could be required if the bowel is badly damaged, the patient is not stabilized or if contamination from infection is severe. 

A colostomy is surgery to create an opening in the abdominal wall. It can be temporary, allowing the bowel to heal, or permanent. The surgeon brings part of the large intestine through that opening, allowing stool to empty into a bag worn on the outside of the body. An ileostomy is similar but involves the small intestine.

Soft Tissue Infections

Soft tissue infections can happen when bacteria invades skin and tissues through a cut, skin tear, scrape or burn. They can be mild and resolve with treatment. However, soft tissue infections can become severe, affecting any part of the body, including skin, underlying tissues and muscles or organs. They can form deep abscesses, can become necrotizing, resulting in tissue death, or they can release bacteria into the bloodstream, causing sepsis. Sometimes, they are the result of infections in surgical sites, infected diabetic foot ulcers or infected pressure sores.

Symptoms of Soft Tissue Infections

• Severe pain that can feel deep and throbbing and gets worse quickly
• Redness and swelling that may cover a large area and spread fast with irregular or indistinct borders
• Fever and chills
• The problem area is hot or warm to the touch and is sore
• Skin changes
  • Blisters or fluid-filled sacs form, and the skin may look purple or gray
  • Skin may feel crackly (crepitus)
  • May look black (indicating dead tissue called necrosis)
• Drainage: There may be bad-smelling discharge that is thick and milky
• Fast heart rate
• Low blood pressure
• Confusion

Treatment for Soft Tissue Infections

Surgery may be needed urgently if there is deep infection or dead or dying tissue. Abscesses can be drained surgically or drained with a needle in an image-guided procedure. Patients with complicated soft tissue infections need to be hospitalized. IV antibiotics are started right away, along with IV fluids, pain medications and care to manage conditions like diabetes.

Expert Emergency Surgery Care

Our board-certified trauma and acute care surgeons have a wealth of experience caring for patients with conditions that require urgent surgery. No matter what time a patient arrives, day or night, they receive high quality medical care from a reputable team of surgeons and specialists with specific expertise in treating emergency conditions.

Our emergency general surgery team offers 24/7/365 in-hospital surgical capabilities and access to sophisticated imaging, multidisciplinary expertise and other critical resources. The team streamlines the admissions process to offer rapid evaluation and treatment and has priority access to operating suites for emergency surgery. The surgeons also coordinate postoperative and follow-up care for every patient to ensure the best possible recovery and outcomes. With keen dedication to surgical quality, our dedicated team prevents complications, reduces costs and saves lives.

Nationally Verified: An Emergency General Surgery Center and Surgical Quality Partner

As an American College of Surgeons (ACS)-verified Emergency General Surgery Center and Surgical Quality Partner, we’re committed to the highest standards of surgical care. This designation reflects our proven record of adhering to the most rigorous standards in surgical quality — minimizing complications, improving outcomes and saving lives. 

Our participation in ACS Quality Programs helps ensure that we continue providing our patients with the best care possible through approved procedures and approaches. When you see the ACS Surgical Quality Partner mark, you can trust that you are getting care from a team dedicated to quality and relentless self-improvement. Building on more than a century of experience improving surgical care, ACS Quality Programs are a definitive measure of quality you can look for as you seek care.