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Case Report

Drain-site hernia causing small-bowel strangulation in a 57-year-old man with gastric cancer 6 months after gastrectomy in India: a case report
Handilu Kath Rengma, Durgesh Ommi, Temsula Alinger
J Acute Care Surg 2025;15(3):170-173.   Published online November 27, 2025
DOI: https://doi.org/10.17479/jacs.2025.0029
Drain‑site hernias are an uncommon but potentially life‑threatening complication following abdominal surgery. We report the case of a 57‑year‑old man with a prior distal gastrectomy who developed acute intestinal obstruction and bowel gangrene due to herniation through a previous drain site. For several months he had a persistent, nontender swelling in the same region that was assumed to be a seroma. He later presented with sudden pain and obstructive symptoms; imaging revealed a small‑bowel loop herniating through an abdominal wall defect. Emergency laparotomy confirmed a strangulated hernia containing nonviable bowel, which was resected. Fascial closure was performed using interrupted sutures. This case highlights the importance of recognizing delayed complications at drain sites and underlines the value of early imaging. Careful drain management, including use of the smallest effective calibre and timely removal, remains critical in preventing such rare but serious postoperative events.
  • 294 View
  • 7 Download

Review Article

Emergency surgery, Basic

Evidence-based conservative and surgical management of adhesive small bowel obstruction: a narrative review
Young Hun Kim, Young Un Choi, Kang Kook Choi, Jinbeom Cho, Dae-Sang Lee, Hohyun Kim, Seong Pyo Mun
J Acute Care Surg 2025;15(2):37-48.   Published online July 30, 2025
DOI: https://doi.org/10.17479/jacs.2025.0009
Adhesive small bowel obstruction (ASBO) is a common postoperative complication and remains a leading cause of emergency surgical admissions. This review synthesizes current evidence regarding the diagnosis, conservative management, and surgical treatment of ASBO, focusing on the role of standardized protocols in optimizing patient outcomes. ASBO most often develops following abdominal or pelvic surgery, especially after open procedures. Conservative management, including nasogastric decompression, water-soluble contrast studies (e.g., Gastrografin), and nutritional support, is effective in 65% to 80% of cases without ischemia or strangulation. However, fever, leukocytosis, persistent pain, or computed tomographic findings (e.g., the whirl sign or bowel wall thickening) necessitate early surgical intervention. Evidence indicates that extending conservative management beyond 3 to 5 days in nonresponders increases both morbidity and mortality. Recent studies do not support routine antibiotic or antispasmodic use in uncomplicated ASBO. Although analgesics and ambulation may provide symptom relief, their impact on surgical timing remains unclear. Laparoscopic adhesiolysis has demonstrated reduced morbidity and shorter hospital stays versus open surgery in appropriately selected patients. Accurate differentiation between ASBO and postoperative ileus is essential for effective treatment. Conservative management remains the first-line approach in cases of partial ASBO, but clinicians must be vigilant for signs of clinical deterioration. Surgical management, including laparoscopic intervention, should be promptly pursued if conservative therapy fails or patients exhibit clinical decline. Implementing evidence-based guidelines and individualized decision-making improves patient safety, reduces complications, and enhances overall outcomes. Ongoing research is needed to refine conservative strategies and identify predictive markers for early surgical intervention.
  • 1,163 View
  • 74 Download

Case Report

Others

The challenge of managing a gigantic bleeding peripheral melanoma in Canada: a case report
Yagan Pillay, Maryna Reshetar
J Acute Care Surg 2025;15(2):73-76.   Published online July 30, 2025
DOI: https://doi.org/10.17479/jacs.2024.0031
Giant melanomas of the peripheral limbs are a rare surgical entity, with fewer than six cases reported in published literature. Previous case reports primarily described attempts at surgical cures utilizing a multidisciplinary approach. We believe this is the first report addressing the complexities of tumor complications specifically from the perspective of acute care surgery. The surgical procedure in this case aimed exclusively at arresting bleeding rather than oncological cure. The role of surgery in addressing complications in palliative care of large tumors is significant. It enhances patient comfort and assists in establishing management guidelines for rare tumors, such as giant peripheral melanoma.
  • 796 View
  • 16 Download

Review Article

Critical care, Infection/Sepsis

Extracorporeal Blood Purification Treatments for Refractory Septic Shock Following Surgery
Eun Young Kim
J Acute Care Surg 2025;15(1):5-12.   Published online March 21, 2025
DOI: https://doi.org/10.17479/jacs.2025.15.1.5
Advancements in perioperative management and surgical techniques have led to an increased frequency of complex surgical procedures and emergency operations, particularly among elderly, and high-risk patients. Consequently, the incidence of severe complications such as intra-abdominal infections has risen, and in some cases, there is progression to refractory septic shock, a life-threatening condition unresponsive to typically effective source control and intensive treatments. Extracorporeal blood purification therapies, including CytoSorb, polymyxin B hemoperfusion (PMX-HP), and AN69-Oxiris, have emerged as adjunctive treatments for refractory septic shock. They remove excessive cytokines and circulating endotoxins, mitigating immune dysregulation, and improving outcomes. CytoSorb filters primarily remove cytokines based on molecular weight, whereas PMX-HP filters remove endotoxin. AN69-Oxiris combines cytokine and endotoxin removal with renal support functionality. Despite their promise, these modalities exhibit limitations such as cost considerations and variability in efficacy. PMX-HP demonstrates superior endotoxin clearance, making it preferable for severe endotoxemia, while AN69-Oxiris offers cost-effective solutions for mild endotoxemia, particularly in patients requiring renal replacement therapy. However, the absence of standardized protocols, and limited direct comparisons hinders widespread adoption. Evidence-based criteria and tailored strategies are essential to optimize the clinical application of blood purification therapies, and improve outcomes for patients with refractory septic shock.
  • 3,342 View
  • 79 Download

Original Articles

Emergency surgery, System

Analysis of Mortality Outcomes and Predictive Factors Following Colorectal Emergency Surgery
Sung Hwan Cho, Gyung Mo Son, Byung-Soo Park, Hyun Sung Kim
J Acute Care Surg 2025;15(1):20-25.   Published online March 21, 2025
DOI: https://doi.org/10.17479/jacs.2025.15.1.20
Purpose
Despite improvements in surgical technology, patients who undergo colorectal emergency surgery still have high mortality and complication rates. This places a high burden on the surgeons and the medical institutions who employ them. Mortality outcomes following emergency colorectal surgery were analyzed and risk factors associated with mortality were identified.
Methods
Data from patients who were admitted through the Emergency Room from June 2019 to December 2021 and underwent emergency colorectal surgery performed by a single surgeon were retrospectively analyzed. Surgical and medical records of various clinicopathological factors and the Mannheim peritonitis index (MPI) scores were compared between survivors and non-survivors.
Results
During the study period, 164 patients underwent colorectal emergency surgery. Following surgery, 24 patients (14.6%) died during their hospital stay. The American Society of Anesthesiologists Classification, the MPI score, indication of surgery, and comorbid disease were factors which showed statistically significant differences between the survivor and non-survivor groups. In particular, in the patients with an MPI score of ≥ 30, 22 of 49 deaths occurred.
Conclusion
Patients undergoing emergency colorectal surgery exhibit high postoperative mortality rates. By identifying these patients before surgery, and allocating appropriate surgical and intensive care resources to them, medical resources can be utilized more efficiently, and mortality rates can be reduced.
  • 1,562 View
  • 33 Download

Trauma, System

Impact of the Implementation of a Trauma Center in a Level III University Hospital: A Single Center's Experience
Annamaria Di Bella, Giovanni Alemanno, Davina Perini, Alessandro Bruscino, Gherardo Maltinti, Rosita De Vincenti, Manuela Bonizzoli, Andrea Nencioni, Michele Citone, Simone Vanni, Francesca Innocenti, Gianluca Frezzetti, Lina Bartolini, Andrea Franci, Simona Di Valvasone, Alessandra Valletta, Massimo Sangiovanni, Paolo De Biase, Rita Piovelli, Irene Cerofolini, Matteo Tomaiuolo, Paolo Prosperi
J Acute Care Surg 2024;14(3):102-112.   Published online November 21, 2024
DOI: https://doi.org/10.17479/jacs.2024.14.3.102
Purpose
A trauma team (TT) is reported to improve the management and polytraumas outcome. To assess the impact on, the decision-making process in the execution of surgical and interventional procedures, trauma patient results were examined before and after TT introduction.
Methods
This was a non-randomized single-center retrospective study of major trauma patients who accessed our level III university hospital Shock Room (SR) in the 20 months prior to the establishment of the TT (preTT group) and in the following 20 months (postTT group).
Results
There were 947 patients (418 preTT, 529 postTT) admitted in the SR due to a traumatic event. Comparing the 2 periods, a significant decreases in time spent in SR (p = 0.008), Sequential Organ Failure Assessment score in the Intensive Care Unit (p = 0.027), and estimated blood loss in Operating Room (p = 0.003) was observed. A significant increase was observed in the number of days of assisted ventilation (p < 0.001), the number of Damage Control Surgery procedures (p = 0.008), and non-operative managements for splenic and liver injuries (p = 0.004).
Conclusion
A significant change in the type of surgical procedures performed and increase in the number of non-operative managements were observed in the period following the implementation of the computed tomography; this was particularly evident in splenic trauma management where a complete alignment with the World Society of Emergency Surgery guidelines recommendations was reached. These results demonstrated the management of traumatic pathology with a dedicated TT represents the best approach for polytraumas.
  • 2,044 View
  • 38 Download

Trauma, System

The Functional, Psychological and Economic Impacts 6 Months Post Major Trauma
Yun Le Linn, Hao Wen Jiang, Norhayati Mohd Jainodin, Pei Leng Chong, Sock Teng Chin, Sachin Mathur
J Acute Care Surg 2023;13(3):105-111.   Published online November 23, 2023
DOI: https://doi.org/10.17479/jacs.2023.13.3.105
Purpose
The consequences of severe traumatic injury extend beyond hospital admission and have the potential for long-term functional, psychological, and economic sequalae. This study investigated patient outcomes 6 months following major trauma.
Methods
Using the National Trauma Registry, database of patients who were admitted between 2016-18 in a tertiary trauma hospital for major trauma [Injury Severity Score (ISS) ≥ 16] a review was performed on 6-month outcomes [including functional outcomes, self-reported state of health and outcome scores (EuroQol-5 Dimension score and Glasgow Outcome Scale Extended)].
Result
There were 637 patients who were treated for major trauma (ISS ≥ 16); the median age was 64 years (range 16-100) and 435 (68.3%) patients were male. The most common injury mechanisms included falling from height (56.5%) and motor vehicle accident (27.0%). The median ISS was 24 (range 16-75). After 6 months, 87.6% of responders were living at home, 25.0% were back to work, and 55.1% were ambulating independently. The median self-rated state of health was 73 at baseline and 64 at 6 months. Age and length of stay were independent predictors of return to ambulation using multivariate analysis. Age, Abbreviated Injury Scale external, Glasgow Coma Scale on Emergency Department arrival, heart rate, and need for transfusion were independent predictors of failure to return to work at 6 months using multivariate analysis. Charlson Comorbidity Index, Glasgow Coma Scale on arrival, temperature, pain and need for inpatient rehabilitation were independent predictors of mortality at 6 months.
Conclusion
Recovery from major trauma is multi-faceted and requires a team-based approach well beyond discharge.
  • 2,937 View
  • 47 Download

Trauma, Basic

Delphi Method Consensus-Based Identification of Primary Trauma Care Skills Required for General Surgeons in Japan
Kazuyuki Hirose, Soichi Murakami, Yo Kurashima, Nagato Sato, Saseem Poudel, Kimitaka Tanaka, Aya Matsui, Yoshitsugu Nakanishi, Toshimichi Asano, Takehiro Noji, Yuma Ebihara, Toru Nakamura, Takahiro Tsuchikawa, Toshiaki Shichinohe, Kazufumi Okada, Isao Yokota, Naoto Hasegawa, Satoshi Hirano
J Acute Care Surg 2023;13(2):58-65.   Published online July 24, 2023
DOI: https://doi.org/10.17479/jacs.2023.13.2.58
Purpose
General surgeons at regional hospitals should have the primary trauma care skills necessary to treat critically ill trauma patients to withstand transfer. This study was conducted to identify a consensus on primary trauma care skills for general surgeons.
Methods
An initial list of acute care surgical skills was compiled, and revised by six trauma experts (acute care surgeons); 33 skills were nominated for inclusion in the Delphi consensus survey. Participants (councilors of the Japanese Society for Acute Care Surgery) were presented with the list of 33 trauma care skills and were asked (using web-based software) to rate how strongly they agreed or disagreed (using a 5-point Likert scale) with the necessity of each skill for a general surgeon. The reliability of consensus was predefined as Cronbach’s α ≥ 0.8, and trauma care skills were considered as primarily required when rated 4 (agree) or 5 (strongly agree) by ≥ 80% participants.
Results
There were 117 trauma care specialists contacted to participate in the Delphi consensus survey panel. In the 1st round, 85 specialists participated (response rate: 72.6%). In the 2nd round, 66 specialists participated (response rate: 77.6%). Consensus was achieved after two rounds, reliability using Cronbach’s α was 0.94, and 34 items were identified as primary trauma care skills needed by general surgeons.
Conclusion
A consensus-based list of trauma care skills required by general surgeons was developed. This list can facilitate the development of a new trauma training course which has been optimized for general surgeons.

Citations

Citations to this article as recorded by  
  • How confident are the general surgeons in Hokkaido region in performing essential trauma skills: a cross-sectional questionnaire survey
    Kazuyuki Hirose, Saseem Poudel, Soichi Murakami, Yo Kurashima, Nagato Sato, Hiroyasu Tojima, Isao Yokota, Kazufumi Okada, Toshiaki Shichinohe, Satoshi Hirano
    World Journal of Emergency Surgery.2025;[Epub]     CrossRef
  • Role of Trauma Surgeons at a Regional Trauma Center in South Korea
    Dongmin Seo, Inhae Heo, Hohyung Jung, Kyoungwon Jung
    Journal of Acute Care Surgery.2024; 14(3): 94.     CrossRef
  • 4,046 View
  • 69 Download
  • 2 Crossref

Emergency surgery, System

Spectrum, Management, and Outcomes of Abdominal Surgical Emergencies at a Referral Hospital in North West Cameroon
Ngwa Ebogo Tagang Titus, Ntih Mariette Liekeh, Ngock Farra Fola George, Sama Akayun, Sena Guylaine Rosine, Nzinga Joy Richie, Nchufor Roland Ndouh, Pisoh Tagnyin Christopher
J Acute Care Surg 2023;13(1):1-9.   Published online March 21, 2023
DOI: https://doi.org/10.17479/jacs.2023.13.1.1
Purpose
Abdominal surgical emergencies are a major health burden in low- and middle-income countries where management is often very challenging, and associated with high morbidity and mortality. The spectrum, management, and outcomes of abdominal surgical emergencies needs to be updated.
Methods
This was a hospital-based retrospective cross-sectional study carried out in Bamenda, Cameroon over a 2-year period. Records of patients who met the inclusion criteria were reviewed, with pre-, intra- and postoperative data collected and analyzed.
Results
There were 207 patients included in this retrospective review (male to female ratio of 1.4:1. The mean age was 47.4 (± 19.4) years. Intestinal obstruction (34.8%) and perforated peptic ulcers (15.5%) were the most common abdominal surgical emergencies. The median delay and interquartile range to presentation and in-hospital delay were 6 (4) days and 8 (12) hours, respectively. The mean length of hospital stay post-surgery was 11days. There were 48.3% of patients who developed a complication; 34.78% were major, 17.9% had an unplanned reoperation, and 15 (7.2%) were readmitted after discharge. The 30-day in hospital mortality was 19.8%. Mortality was independently associated with a high American Society of Anesthesiologists (ASA) score; ASA score > 3, age > 60 years, and referral from other health facilities.
Conclusion
Intestinal obstructions from intraperitoneal neoplasm is the most common cause of abdominal surgical emergency in North West Cameroon. Abdominal emergencies here are associated with a very high morbidity and mortality in males > 60 years with an ASA score > 3 and with more than one comorbidity.

Citations

Citations to this article as recorded by  
  • Determinants of surgical management outcomes among adult patients with intestinal obstruction at Mzuzu central hospital, Malawi
    Dickson Mwenitete, Chank Mwalweni, Violet Moyo, Frank Banda, Sope Msuku, Patrick Mapulanga, Judith Mkwaila, Rodwell Gundo
    BMC Surgery.2025;[Epub]     CrossRef
  • 5,703 View
  • 112 Download
  • 1 Crossref

Emergency surgery, Basic

Open Abdominal Management Among Non-Trauma Patients: The Appropriate Duration and a New Clinical Index
Koichi Inukai, Akihiro Usui, Yu Hashimoto, Fumitaka Kato, Koji Amano, Hiroyuki Kayata, Nobutaka Mukai, Naoki Shinyama
J Acute Care Surg 2022;12(3):97-102.   Published online November 23, 2022
DOI: https://doi.org/10.17479/jacs.2022.12.3.97
Purpose
Despite widespread adoption of open abdominal management (OAM), there is currently no threshold criterion for OAM duration for non-trauma patients. Moreover, there is a positive relationship between morbidity and the duration of OAM, but an uncertain relationship with patients’ age. Therefore, a novel clinical index for the duration of open abdominal management (IDOM) was developed based on the patient’s age and risk of severe complications following OAM to indicate the maximum tolerable number of days of OAM based on the individual’s age. The utility of this new index was evaluated.
Methods
This retrospective study included 65 non-trauma patients managed with an open abdomen (OA) from August 2015 to August 2018. The IDOM was developed based on the patient’s age. The result indicated the maximum number of OA days. Patients’ demographic and operative variables were examined and patient data was assigned to one of two groups according to whether the actual number of OA days was above or below the calculated IDOM. Prevalence of complications between these groups was compared. Measures of validity were employed to assess the utility of the IDOM for patient complications.
Results
Sixty-five patients were included. The above-the calculated IDOM group exhibited a significantly longer OA and higher rates of wound complications and postoperative respiratory complications compared with the below the calculated IDOM group. The IDOM predicted the incidence of OA-related complications with a sensitivity of 72.4%, and a specificity of 80.6%.
Conclusion
The IDOM is a potentially useful tool for appropriate duration at the outset of OA.
  • 3,362 View
  • 41 Download

Review Article

Critical care, System

New Concept of a Surgical Hospitalist: Early Experience of Managing the Admission, Critical Care, Trauma Surgery Team
Sungho Lee, Kwanhoon Park, Kang Yoon Lee, Ji Young Jang
J Acute Care Surg 2022;12(3):91-96.   Published online November 23, 2022
DOI: https://doi.org/10.17479/jacs.2022.12.3.91
The demand for hospitalists is increasing due to decreasing numbers of clinical residents and increased concerns regarding patient safety. However, several limitations in the surgical hospitalist role exist. The personnel of the surgical hospitalist, rapid response team (RRT), surgical critical care, and trauma surgery teams were unified under the admission, critical care, and trauma surgery (ACTs) team at this institution. The ACTs target are patients with severe disease not undergoing general postoperative course, or patients with the potential for severe conversion. Two surgical intensivists are on duty once a week and oversee the intensive care unit (ICU), the back-up treatment of critically ill patients, and the immediate treatment of trauma patients. ACTs also participate in the surgical RRT and select patients with a high probability of severe exacerbation. Between 2019-2021, the cardiopulmonary resuscitation incidence per 1,000 hospitalized patients in the surgical department decreased significantly from 0.81 to 0.55. From March to December 2021, the ACTs team were involved with 101 of 158 surgical patients admitted to the ICU: 62 with postoperative status, 29 with severe trauma, and 10 transferred to the ICU via RRT screening. Based on our experience, the role of the ACTs team can help improve patient safety.

Citations

Citations to this article as recorded by  
  • Impact of Resident Shortage on Trauma Care During the 2024 Medical Conflict: A Single Regional Emergency Medical Center Experience and Recommendations
    Jun Hyung Kim, Sungho Lee, Kwanhoon Park, Kang Yoon Lee, Ji Young Jang
    Journal of Acute Care Surgery.2025; 15(1): 13.     CrossRef
  • 4,383 View
  • 60 Download
  • 1 Crossref

Original Articles

Nutrition, System

The Status of Protein Supply to Patients in the Trauma and Surgical Intensive Care Units and the Effects of Feedback on Protein Supply: A Multicenter Study
Seung-Young Oh, Jae-Myeong Lee, Han Young Lee, Junsik Kwon, Hak-Jae Lee, Nak-Jun Choi, Jae Gil Lee, Im-Kyung Kim, Min Chang Kang, Hyung Won Kim, Seok Hwa Youn
J Acute Care Surg 2022;12(3):132-137.   Published online November 23, 2022
DOI: https://doi.org/10.17479/jacs.2022.12.3.132
Purpose
To investigate the status of protein supply by comparing the recommended amount with the delivered amount of protein in patients in the trauma and surgical intensive care units (ICU). Feedback on the protein supply status was presented to each hospital, and we evaluated whether the protein supply had increased to an appropriate level.
Methods
In this retrospective observational multicenter study, nutritional information on patients in the trauma and surgical ICUs who had received nutritional support intervention was collected on the 1st Wednesday of each month at two-month intervals from August 2020 to June 2021, from nine domestic hospitals in Korea. Every two months, the nutritional status of each hospital was shared with all hospitals, and each nutritional support team received feedback on protein supply status.
Results
There were 246 patients from nine hospitals included in this study, and data over the study period from six protein days, were analyzed. The mean ratios of delivered calories to calculated required calories were 74.0%, 80.8%, 85.4%, 77.9%, 71.3%, and 82.1% on Protein Days 1, 2, 3, 4, 5, and 6, respectively. The mean ratios of delivered protein to calculated required protein were 73.0%, 77.2%, 78.9%, 79.3%, 69.4%, and 89.6% on Protein Days 1, 2, 3, 4, 5, and 6, respectively.
Conclusion
Protein supply increased to an appropriate level, feedback on protein supply status may have increased the protein supply ratio and promoted appropriate protein supply and nutritional support for patients in the trauma and surgical ICUs.

Citations

Citations to this article as recorded by  
  • Early Adequate Nutrition in ICU Is Associated with Survival Gain : Retrospective Cohort Study in Patient with Traumatic Brain Injury
    Junseo Oh, Jingyeong Kim, Jihyeon Ahn, Sunghoon Choi, Hyung Min Kim, Jaeim Lee, Hang Joo Cho, Maru Kim
    Journal of Korean Neurosurgical Society.2025; 68(2): 177.     CrossRef
  • 5,006 View
  • 61 Download
  • 1 Crossref

Critical care, AKI

Risk Factors Associated with 30-day Mortality in Patients with Postoperative Acute Kidney Injury Who Underwent Continuous Renal Replacement Therapy in the Intensive Care Unit
Kang Yoon Lee, Kwanhoon Park, SungHo Lee, Ji Young Jang, Keum Seok Bae
J Acute Care Surg 2022;12(2):47-52.   Published online July 22, 2022
DOI: https://doi.org/10.17479/jacs.2022.12.2.47
Purpose
To evaluate the risk factors associated with 30-day mortality in patients with postoperative acute kidney injury who underwent continuous renal replacement therapy (CRRT).
Methods
Retrospective analysis of the medical charts of patients with postoperative acute kidney injury who underwent CRRT in the intensive care unit between April 2012 and May 2019 was conducted.
Results
There were 71 patients whose average age was 64.8 years, and average Acute Physiology and Chronic Health Evaluation 2 score was 26.2. There were 37 patients who had non-trauma emergency surgery, 16 who required trauma surgery, and 18 who had elective major surgery. In most patients, CRRT was started based on Stage 3 Acute Kidney Injury Network criteria, and the mean creatinine level at the time of CRRT initiation (3.62 mg/dL). The median period from surgery to CRRT was 3 days, and the median CRRT application was 4 days. Forty-seven patients died within 30 days of receiving CRRT. Age, elective major surgery, creatinine level on initiation of CRRT, use of norepinephrine upon the initiation of CRRT, and average daily fluid balance/body weight for 3 days following the initiation of CRRT were associated with increasing 30-day mortality in univariate analysis. In multivariate analysis, age, major elective surgery, and norepinephrine use upon initiation of CRRT were identified as independent risk factors for 30-day mortality.
Conclusion
Surgical patients who underwent CRRT postoperatively had a poor prognosis. The risk of death in elderly patients who have undergone major elective surgery, or are receiving norepinephrine upon initiation of CRRT should be considered.
  • 4,915 View
  • 88 Download

Case Reports

Emergency surgery, Organ(liver, bowel, kideny etc.)

Superior Mesenteric Artery Syndrome: Late Complication of Ileal Pouch-Anal Anastomosis
Gregory Wu, Brianna Bockman, Mohammad Saba, Abiola Mosuro
J Acute Care Surg 2022;12(2):86-89.   Published online July 22, 2022
DOI: https://doi.org/10.17479/jacs.2022.12.1.2.86
Superior mesenteric artery syndrome (SMAS) is an uncommon condition which is difficult to diagnose due to non-specificity of symptoms. The most common causes of SMAS are severe weight loss secondary to severe medical conditions, surgical history, and cancer. A 31-year-old male with a history of ulcerative colitis status-post proctocolectomy with ileal pouch-anal anastomosis 10 years prior, presented with progressively worsening weight loss and abdominal pain. Radiographic imaging was consistent with SMAS, which was subsequently confirmed intraoperatively during an emergency surgery in which a Roux-En-Y gastrojejunostomy was performed. Clinicians should be aware that SMAS is a rare but possible complication of ileal pouch-anal anastomosis. Although rare, there should be a low threshold for this diagnosis when obstructive symptoms present.

Citations

Citations to this article as recorded by  
  • Superior mesenteric artery syndrome following colorectal surgery: a systematic review
    Nourah Alsaleh, Waed Yaseen, Renad Abo Alshamat, Raghad Aljurushi, Basem Alshareef
    Annals of Medicine & Surgery.2025; 87(5): 2763.     CrossRef
  • 4,309 View
  • 36 Download
  • 1 Crossref

Emergency surgery, Organ(liver, bowel, kideny etc.)

The Occurrence of a Thyroid Storm in a Patient with Recurrent Refractory Peptic Ulcer: A Case Report
Kwanhoon Park, Ji Young Jang, Sungho Lee
J Acute Care Surg 2022;12(1):39-42.   Published online March 24, 2022
DOI: https://doi.org/10.17479/jacs.2022.12.1.39
A thyroid storm is a rare complication of hyperthyroidism. Although a thyroid storm rarely presents with symptoms similar to those of an acute abdomen, and in cases where emergency surgery is needed, the thyroid function test is not performed routinely. In this study, we report a case in which hyperthyroidism was diagnosed after surgery in a patient with recurrent refractory peptic ulcer disease. Although peptic ulcer disease and hyperthyroidism rarely coexist, when the patient's initial condition was reviewed in the Emergency Department, the findings were reasonable for panperitonitis due to peptic ulcer perforation, which is considered as a condition suitable for a thyroid storm. This isolated case indicates a logical leap in the correlation between peptic ulcer and thyroid storm. In recurrent refractory peptic ulcer disease, the thyroid function test may be helpful as a routine laboratory test before emergency surgery.
  • 4,883 View
  • 80 Download

Original Article

Trauma, Organ(liver, bowel, kideny etc.)

Management of Traumatic Duodenal Injuries: A Report from a Single-Center
Seok Min Kang, Im-kyung Kim, Jae Gil Lee
J Acute Care Surg 2022;12(1):24-28.   Published online March 24, 2022
DOI: https://doi.org/10.17479/jacs.2022.12.1.24
Purpose
Traumatic duodenal injury is uncommon and due to its difficult diagnosis and accessibility there is an increased risk of mortality and morbidity.
Methods
Electronic medical records of a single center were reviewed retrospectively from March 2008 to December 2020 and a total of 7 cases of traumatic duodenal injury were managed by surgical exploration. The site of duodenal perforation, injury mechanisms, operation method, and postoperative outcomes were assessed.
Results
The mean age was 55.72 years (range, 34-78), and there were 5 men in the study. The most common mechanism was in-car traffic accident (4 cases), and 1 case each of pedestrian accident, accident during work, and self-injured stab wound. The most common site of injury was between the 3rd and 4th portion (3 cases), followed by the bulb and 1st portion (2 cases), and 2nd portion (2 cases). Segmental resection of the duodenum and primary anastomosis was performed in the 3rd and 4th portion perforation. In cases of 1st and 2nd portion, injury was managed by primary repair or pylorus preserving pancreaticoduodenectomy. Complications developed in 4 patients, and the most common complication was a problem with the wound; wound seromas developed in 4 cases, entero-cutaneous fistula in 1, and biliary complications in 2 cases. Two patients suffered from intraperitoneal abscess or fluid collection managed by percutaneous drainage. The mean duration of hospital stay was 34 days, and postoperative mortality did not develop.
Conclusion
Favorable clinical outcomes were observed in patients with traumatic duodenal injury managed by various surgical approaches.
  • 4,248 View
  • 119 Download

Case Report

Trauma, Emergency surgery

Case Report of a Laparoscopic Primary Diaphragmatic Repair in Acute Penetrating Trauma: Is It Within the Realm of an Acute Care Surgeon?
Yagan Pillay, Cheyenne Vetter
J Acute Care Surg 2021;11(2):78-81.   Published online July 7, 2021
DOI: https://doi.org/10.17479/jacs.2021.11.2.78
The laparoscopic repair of traumatic diaphragmatic injuries in the acute phase has not been well established. The current consensus view is an elective repair by a surgeon with an advanced laparoscopic skill set. This case report illustrates the position that with judicious patient selection an acute repair is not only possible but well within the realm of an acute care surgeon. Anterior diaphragmatic injuries with penetrating trauma can even be repaired primarily without the need for prosthetic reinforcement. It is hoped that this case report will add to the surgical armamentarium of the acute care surgeon.
  • 5,764 View
  • 72 Download

Original Articles

Emergency surgery, Procedure

Intra-Abdominal Gauze Packing for Uncontrolled Hemorrhage in Non-Trauma Patients
Jin-Myung Kim, Chan Wook Kim, Suk-Kyung Hong, Hak Jae Lee, Chang Sik Yu, Jin Cheon Kim
J Acute Care Surg 2021;11(2):64-70.   Published online July 7, 2021
DOI: https://doi.org/10.17479/jacs.2021.11.2.64
Purpose
The outcomes of non-trauma patients requiring intra-abdominal gauze packing for the management of uncontrollable hemorrhage following surgery, and the evaluation of survival risk factors were examined.
Methods
Data from patients who underwent intra-abdominal gauze packing to control bleeding during abdominal surgery between September 2012 and March 2019 were retrospectively reviewed.
Results
A total of 28 patients were included in the study population analysis. There were 9 patients who died during hospitalization. One patient died as a result of uncontrolled bleeding. In spite of gauze packing, 2 patients who had increasing blood transfusion requirements (> 4 packs/4 hours) were found to have arterial bleeding. Univariate analysis for hospital death showed that immunocompromised status, emergency surgery, a thrombocytopenic state prior to initial surgery, and a longer duration until gauze removal had a negative association with survival outcomes. Among these factors, only time to gauze removal > 36 hours was identified as an independent risk factor for survival outcome in the multivariate analysis.
Conclusion
Gauze packing could be considered as an effective method for the management of uncontrolled hemorrhage, in non-trauma patients. In cases of persistent bleeding after gauze packing, arterial bleeding should be suspected. Gauze removal after > 36 hours may indicate a poor survival outcome.
  • 7,562 View
  • 137 Download

Procedure, Emergency surgery

Feasibility of the Gastrografin Challenge for Adhesive Small Bowel Obstruction
Ki-Sang Jung, Kyoung Jin Choi, Kyoung Won Yoon, Keesang Yoo, Eunmi Gil, Chi-Min Park
J Acute Care Surg 2021;11(2):58-63.   Published online July 7, 2021
DOI: https://doi.org/10.17479/jacs.2021.11.2.58
Purpose
This retrospective study investigated the feasibility, diagnostic, and therapeutic advantages of the gastrografin challenge on patients with adhesive small bowel obstruction (ASBO).
Methods
There were 125 patients reviewed who were admitted to the Department of General Surgery at a single institution (September 2018 to August 2019) with a diagnosis related to ASBO. The study population included 100 patients (114 cases) who had received initial conservative management. Patient characteristics and operation rates were compared between the gastrografin challenge success group and failure group, and operation rates and length of hospital stay were compared between the gastrografin challenge group and “non-challenge” group.
Results
During the study period, 21 patients with ASBO underwent the gastrografin challenge. The challenge was successful in 17 patients where the bowel obstruction was resolved without the need for surgery. Among patients who failed the challenge, 2 patients underwent adhesiolysis and 2 patients were able to progress their diet avoiding surgery. In patients who underwent surgery (n = 2), the length of hospital stay was significantly shorter in the gastrografin challenge group compared with the “non-challenge” group sub analysis (n = 13 cases; 10.5 vs. 20 days, p = 0.038), indicating that the gastrografin challenge assisted rapid decision-making for surgery. No adverse events were reported for the 21 gastrografin challenges.
Conclusion
In patients with ASBO, the gastrografin challenge is an accurate, safe method to determine the need for surgery. In addition, the gastrografin challenge may reduce the length of stay in patients who required surgery for ASBO resolution.
  • 8,220 View
  • 239 Download

Case Report

Emergency surgery

Laparoscopic Tissue Repair of an Acutely Incarcerated Spigelian Hernia
Yagan Pillay, Rufaro Asefa
J Acute Care Surg 2021;11(1):36-38.   Published online March 24, 2021
DOI: https://doi.org/10.17479/jacs.2021.1.36
Spigelian hernias are a rare type of abdominal wall hernia. A weakness in the spigelian fascia causes abdominal contents to herniate between the abdominal muscle layers as an interparietal hernia. We present the case of a 72-year old woman with acute onset abdominal pain and distention. A computed tomography scan revealed an incarcerated spigelian hernia with small bowel obstruction. This necessitated an acute surgical intervention with a laparoscopic tissue repair. The case is unique as our patient had a large hernial neck measuring 4.8 centimeters, one of the largest in published literature. The laparoscopic tissue repair is outside the current norm for this type of hernial repair and remains a rare type of surgical herniorrhaphy. Laparoscopic ventral hernia repair in the acute setting should form part of the surgical skill set of acute care surgeons as borne out by the published literature and this case report.
  • 6,655 View
  • 75 Download

Original Articles

Critical care

Usefulness of Echocardiography for General Surgery Patients on Intensive Care Units: When and How?
Jai-Hyun Chung, Namryeol Kim
J Acute Care Surg 2021;11(1):22-29.   Published online March 24, 2021
DOI: https://doi.org/10.17479/jacs.2021.1.22
Purpose
Echocardiography is useful in the management of critically ill patients, but there are few studies on the usefulness of an echocardiography for critical general surgery patients. This study aimed to address this by analyzing the indications and findings for and clinical outcomes between (1) chest trauma; (2) cardiac specific pathology; and (3) hemodynamic instability groups of critical general surgery patients

Methods
Retrospective analysis was performed on the medical records data from the last 5 years of general surgery patients who were admitted to the intensive care unit (ICU) and had an echocardiography at least once during their ICU stay. The patient data were divided into 3 groups according to the indication for an echocardiography and based on the clinical situation. Demographics, the ratio of positive echocardiography findings, and clinical outcomes including the length of hospital stay, length of ICU stay, and in-hospital mortality were analyzed among these groups.

Results
There were statistical differences in the rate of positive echocardiography findings (p = 0.018) and in-hospital mortality (p = 0.001) amongst the groups with different echocardiography indications; there was no difference in the length of stay. Patients who had an echocardiography due to hemodynamic instability or cardiologic pathology presented with a higher ratio of positive echocardiography findings and mortality, compared with the chest trauma patient group. The chest trauma group showed the lowest rate of positive echocardiography findings (7%).

Conclusion
Echocardiographies are useful for general surgery patients in ICUs when there are indications such as previous cardiac pathology history or hemodynamic instability.
  • 4,437 View
  • 74 Download

Emergency surgery

10 Years of Acute Care Surgery: Experiences in a Single Tertiary University Hospital in Korea
Tae Hyun Kim, Jung Yun Park, Yun Tae Jung, Seung Hwan Lee, Myung Jae Jung, Jae Gil Lee
J Acute Care Surg 2020;10(3):96-100.   Published online November 20, 2020
DOI: https://doi.org/10.17479/jacs.2020.10.3.96
Purpose
Acute care surgery (ACS) has been shown to improve patient outcome and treatment efficiency in the U.S. ACS was introduced to the Department of Surgery, Yonsei University College of Medicine, Seoul to solve the problems associated with delays in surgical evaluation of non-trauma patients who needed emergency surgery, and to offer exposure to a wide variety of surgical cases to general surgical fellows and residents. The objective of this study was to describe the 10-year experience of the ACS department in a single center.
Methods
A retrospective chart review was conducted at the Department of Surgery, Yonsei University College of Medicine, Seoul, for all patients admitted from March 2008 to February 2018. Patients were grouped into either the trauma or non-trauma group, and were further classified according to their diagnosis, and the type of operations they had undergone.
Results
There was a total of 2,805 patients, including 1,001 trauma patients and 1,804 non-trauma patients. The average hospital length of stay was 14 days and the total in-hospital mortality rate was 3.6%. Trauma mechanisms included blunt (92.6%), penetrating (7.0%) and burn (0.4%) trauma. The majority of non-trauma patients were admitted for appendicitis (37.1%), followed by cholecystitis (21.7%). There was a total of 1,561 operations conducted. The most frequent operations were appendectomy (38.3%) and cholecystectomy (19.5%), followed by adhesiolysis (7.8%).
Conclusion
A working ACS department has been implemented in a Korean medical center.

Citations

Citations to this article as recorded by  
  • Development of an ICT Laparoscopy System with Motion-Tracking Technology for Solo Laparoscopic Surgery: A Feasibility Study
    Miso Lee, Jinwoo Oh, Taegeon Kang, Suhyun Lim, Munhwan Jo, Min-Jae Jeon, Hoyul Lee, Inhwan Hwang, Shinwon Kang, Jin-Hee Moon, Jae-Seok Min
    Applied Sciences.2024; 14(11): 4622.     CrossRef
  • Difficult Small Bowel Bleeding in Surgical View
    Jung Min Bae
    Journal of Acute Care Surgery.2024; 14(2): 41.     CrossRef
  • Clinical significance of acute care surgery system as a part of hospital medical emergency team for hospitalized patients
    Kyoung Won Yoon, Kyoungjin Choi, Keesang Yoo, Eunmi Gil, Chi-Min Park
    Annals of Surgical Treatment and Research.2023; 104(1): 43.     CrossRef
  • 6,877 View
  • 114 Download
  • 3 Crossref

Review Article

Trauma, Procedure

A Feasible Operative Treatment Strategy for Trauma Patient with Difficulties in Closing the Abdomen during Open Abdomen Management (OAM) Following Damage Control Surgery-Secondary Publication
Futoshi Nagashima, Satoshi Inoue
J Acute Care Surg 2020;10(3):83-89.   Published online November 20, 2020
DOI: https://doi.org/10.17479/jacs.2020.10.3.83
The vacuum packing closure (VPC) is often performed as temporal abdominal closure after damage control surgery (DCS). We occasionally encounter severe trauma patients whose abdomens were unable to be closed after DCS. The bilateral anterior rectus abdominis sheath flap turnover method and component separation (CS) method are one of the options to close the abdomen. However, it can be challenging to close the abdomen in some patients with very severe trauma or obesity by these methods. The open abdomen management (OAM) with a planned ventral hernia can be performed in those patients. The patients with long term OAM occasionally develop persistent enteroatmospheric fistula (EAF). The VPC using absorbable mesh is useful to reduce the likelihood of EAF. The posterior component separation with transversus abdominis release is a useful method for delayed abdominal wall reconstruction following planned VH if bilateral anterior rectus abdominis sheath flap turnover method and CS method are unable to be performed.

Citations

Citations to this article as recorded by  
  • Delayed open abdomen closure using a combination of acellular dermal matrix and skin graft in Korea: a case report
    Yoonseob Kim, Tae Ah Kim, Hyung Min Hahn, Byung Hee Kang
    Journal of Trauma and Injury.2023; 36(2): 152.     CrossRef
  • 6,760 View
  • 128 Download
  • 1 Crossref

Original Articles

Trauma, Trauma

Surgical Volumes in a Regional Trauma Center: Is It Enough?
Mina Lee, Giljae Lee, Jungnam Lee, Byungchul Yu
J Acute Care Surg 2020;10(1):10-12.   Published online March 30, 2020
DOI: https://doi.org/10.17479/jacs.2020.10.1.10
Purpose
This study evaluated the surgical volumes and types of specific surgical procedures in a single trauma center for 3 consecutive years.
Methods
From January 2014 to December 2016 there were 9,530 injury cases in the trauma registry that were reviewed.
Results
There were 1,502 patients (15.8%) with an injury severity score over 15, of which 426 (28.4%) underwent an emergency operation or had an interventional radiology procedure. There were 186 craniotomies, 87 laparotomies, and 74 interventional radiology procedures performed.
Conclusion
The number of emergency operations by each dedicated trauma surgeon was very low therefore implementation of an acute-care surgery model is appropriate to consider together with changes to the training program for trauma surgeons.

Citations

Citations to this article as recorded by  
  • Integrating acute care surgery in South Korea: enhancing trauma and non-trauma emergency care
    Jin Young Lee, Seheon Kim, Jin Bong Ye, Jin Suk Lee, Younghoon Sul
    World Journal of Emergency Surgery.2025;[Epub]     CrossRef
  • Role of Trauma Surgeons at a Regional Trauma Center in South Korea
    Dongmin Seo, Inhae Heo, Hohyung Jung, Kyoungwon Jung
    Journal of Acute Care Surgery.2024; 14(3): 94.     CrossRef
  • Understanding Regional Trauma Centers and managing a trauma care system in South Korea: a systematic review
    Jeehye Im, Eun Won Seo, Kyoungwon Jung, Junsik Kwon
    Annals of Surgical Treatment and Research.2023; 104(2): 61.     CrossRef
  • Trauma provision in South-West Nigeria: Epidemiology, challenges and priorities
    Tochukwu Nonso Enemuo
    African Journal of Emergency Medicine.2022; 12(3): 276.     CrossRef
  • 6,256 View
  • 108 Download
  • 4 Crossref

Critical care, System

Evaluation of Medical Emergency Team Activation in Surgical Wards
Moon Suk Choi, Dae Sang Lee, Chi Min Park
J Acute Care Surg 2019;9(2):54-59.   Published online October 30, 2019
DOI: https://doi.org/10.17479/jacs.2019.9.2.54
Purpose
A review was performed to determine the frequency of activating medical emergency teams (MET) in surgical wards, so that resource allocation could be optimized.
Methods
A retrospective observational study was performed to determine the time and frequency when MET were deployed (N = 465) to patients (n = 387) who were admitted to the surgical ward, from March 2013 to July 2016 due to emergency situations.
Results
Of the 465 MET activations, 8 did not incur any further intervention. The review showed an average of 151 minutes from onset of symptoms to MET activation, and an average of 110 minutes until intervention (additional diagnosis / treatment). The number of MET activations increased year by year from 2013 to 2016. The transfer of patients to the intensive care units also increased from 34 in 2013, to 82 in 2016. The lowest number of MET activations occurred between 04:00 and 05:00, but there was no difference in the number of MET activations between day and night. However, MET activation in response to acute respiratory distress was significantly higher during the nighttime (p = 0.003).
Conclusion
Patients admitted to a surgical ward have more serious complications. This study showed that the use of MET in surgical wards has increased year by year, and the frequency of calls between day and night was not different, except higher MET activations observed at night in patients with acute respiratory distress.

Citations

Citations to this article as recorded by  
  • Clinical significance of acute care surgery system as a part of hospital medical emergency team for hospitalized patients
    Kyoung Won Yoon, Kyoungjin Choi, Keesang Yoo, Eunmi Gil, Chi-Min Park
    Annals of Surgical Treatment and Research.2023; 104(1): 43.     CrossRef
  • 6,787 View
  • 80 Download
  • 1 Crossref

Review Articles

Organ(liver, bowel, kideny etc.), Basic

Acute Appendicitis
Daibo Kojima, Ari Leppäniemi, Suguru Hasegawa
J Acute Care Surg 2019;9(2):31-34.   Published online October 30, 2019
DOI: https://doi.org/10.17479/jacs.2019.9.2.31
Acute appendicitis (AA) is one of the most common causes of acute abdominal pain, which can progress to perforation of the appendix and peritonitis. Recently, AA has been classified into uncomplicated (nonperforated, no phlegmon) or complicated (abscess, perforation, phlegmon) appendicitis, for an appropriate initial treatment. With respect to surgical treatment of AA, laparoscopic surgery has been widely accepted worldwide as a safe and feasible first-line treatment. Over the last decade, nonoperative treatment has been proposed as an alternative to surgery in uncomplicated AA, and has also played an important role in the management of complicated AA. AA is also the most common cause for abdominal surgery during pregnancy, though an accurate diagnosis of AA during pregnancy is challenging. In this review, the topics being discussed include: 1) Non-operative management for uncomplicated AA, 2) Management for AA in pregnancy, 3) Management for complicated appendicitis (especially immediate laparoscopic surgery for appendiceal abscess), 4) Appendiceal neoplasms related to complicated AA.
  • 9,721 View
  • 403 Download

System, Emergency surgery

Acute Care Surgery: Implementation in Korea
Chan Ik Park, Jae Hun Kim, Sung Jin Park, Seon Hee Kim, Ho Hyun Kim, Suk-Kyung Hong, Chi-Min Park
J Acute Care Surg 2018;8(2):51-58.   Published online October 30, 2018
DOI: https://doi.org/10.17479/jacs.2018.8.2.51

The concept of acute care surgery (ACS) incorporates trauma, surgical critical care, and emergency general surgery. It was designed in the early 2000s by the United States as a solution to the looming crisis of trauma care and non-trauma emergency surgery. Reduced surgical opportunities for trauma surgeons resulted in a decreased interest in trauma surgery. Surgical sub-specialization further accelerated an indifference towards trauma and emergency general surgery. Started in 2008, the trauma center project in Korea is still in its infancy. Although the need for ACS was presented since the inception of the trauma center project, there was a lack of implementation at trauma centers due to government regulations. However, ACS has been initiated at several non-trauma center hospitals and is mainly operated by surgical intensivists. Studies demonstrate that adding emergency surgery to a trauma service does not compromise the care of the injured patients, despite an increase in trauma volume. Positive impacts of ACS are reported by numerous researches. We believe that the development and advancement of trauma centers will necessitate a discussion for the implementation of the ACS model at trauma centers in Korea.

Citations

Citations to this article as recorded by  
  • Clinical outcomes of the implementation of acute care surgery system in South Korea: a multi‐centre, retrospective cohort study
    Gun‐Hee Yi, Suk‐Kyung Hong, Yang‐Hee Jun, Sungyeon Yoo, Jung‐Min Bae, Keesang Yoo, Yun Tae Jung, EunYoung Kim, Narae Lee, Min Jung Ko, Hogyun Shin, Hak‐Jae Lee
    ANZ Journal of Surgery.2025; 95(3): 416.     CrossRef
  • Integrating acute care surgery in South Korea: enhancing trauma and non-trauma emergency care
    Jin Young Lee, Seheon Kim, Jin Bong Ye, Jin Suk Lee, Younghoon Sul
    World Journal of Emergency Surgery.2025;[Epub]     CrossRef
  • Outcomes in emergency surgery following the implementation of an acute care surgery model: a retrospective observational study
    Sungyeon Yoo, Yang-Hee Jun, Suk-Kyung Hong, Min Jung Ko, Hogyun Shin, Narae Lee, Hak-Jae Lee
    Annals of Surgical Treatment and Research.2024; 107(5): 284.     CrossRef
  • Clinical significance of acute care surgery system as a part of hospital medical emergency team for hospitalized patients
    Kyoung Won Yoon, Kyoungjin Choi, Keesang Yoo, Eunmi Gil, Chi-Min Park
    Annals of Surgical Treatment and Research.2023; 104(1): 43.     CrossRef
  • 10 Years of Acute Care Surgery: Experiences in a Single Tertiary University Hospital in Korea
    Tae Hyun Kim, Jung Yun Park, Yun Tae Jung, Seung Hwan Lee, Myung Jae Jung, Jae Gil Lee
    Journal of Acute Care Surgery.2020; 10(3): 96.     CrossRef
  • 6,923 View
  • 110 Download
  • 5 Crossref

Original Article

Emergency surgery, Basic

Blood Transfusions for Emergency Laparotomies in General Surgery
Vignesh Narasimhan, Robert Spychal, Charles Pilgrim
J Acute Care Surg 2017;7(1):15-22.   Published online April 30, 2017
DOI: https://doi.org/10.17479/jacs.2017.7.1.15
Purpose:

Decisions regarding perioperative blood transfusions are subject to clinical and laboratory factors. Blood transfusions are associated with increased risk of infection, sepsis, organ failure, and length of stay. Current guidelines on transfusions are based on elective settings. There is a paucity of data on blood transfusion use in emergency surgery. This study reviews the appropriateness of blood transfusions in patients undergoing emergency general surgical laparotomies.

 Methods:

Patients undergoing emergency general surgical laparotomies at Peninsula Health from January 2013 to May 2015 were reviewed. Hemoglobin (Hb) levels triggering transfusion and overall blood utilization were obtained. Transfusions were classified based on whether they were given pre-, intra- or postoperatively. Transfusions with Hb ＞80 g/L in the absence of bleeding or preoperative anemia were deemed ‘inappropriate’ as per Australian Blood Authority guidelines.

 Results:

Over the 29-month period, 368 patients underwent 398 emergency laparotomies. Blood transfusions were given to 102 patients (27.7%). These patients required 240 transfusion episodes. Patients were given a median of three units of blood. One hundred and sixty-six transfusions (69.2%) were postoperative. Forty-six transfusions (19.2%) were given with Hb ＞80 g/L in the absence of other indications, and were deemed inappropriate. Inappropriate transfusions occurred more frequently on the ward compared to ICU (p<0.05). Almost two thirds of inappropriate transfusions were given for Hb 80∼85 g/L.

 Conclusion:

Nearly one in five patients received an inappropriate transfusion. More judicious use of blood products in emergency patients is required, especially on surgical wards.

Citations

Citations to this article as recorded by  
  • Routine blood group and antibody screening prior to emergency laparoscopy
    J Barrett-Lee, J Vatish, M Vazirian-Zadeh, P Waterland
    The Annals of The Royal College of Surgeons of England.2018; 100(4): 322.     CrossRef
  • 7,652 View
  • 27 Download
  • 1 Crossref

Original article

System,

Acute Care Surgery Model for Emergency Cholecystectomy
Myoung Je Song, Kyoung Mi Lee, In Byung Kim, Heon-Kyun Ha, Wan Sung Kim, Hyoun Jong Moon, Jin Ho Jeong, Kang Kook Choi
J Acute Care Surg 2016;6(2):57-61.   Published online October 30, 2016
DOI: https://doi.org/10.17479/jacs.2016.6.2.57
Purpose

Acute care surgery (ACS) models have evolved worldwide over the last decade. However, South Korea has an established trauma system and does not consider the ACS model. This study compares the management and outcome of emergency cholecystectomy in the ACS model to those of traditional on-call attending surgeon model for emergency surgery.

 Methods

Retrospectively collected data for patients who underwent emergency cholecystectomy from May 2013 to January 2015 was analyzed to compare data from a traditional on-call system (OCS) and ACS.

 Results

One hundred and twenty-four patients were enrolled in the study (62 patients ACS vs. 62 patients OCS). Hospital stay (days) (ACS=4.29±2.49 vs. OCS=4.82±4.48, p=0.46) and stay in emergency room (minutes) (ACS=213.10±113.99 vs. OCS=241.10±150.73, p=0.20) did not differ significantly between groups. Operation time (minutes) was significantly shorter in the ACS than OCS group (389.97±215.21 vs. 566.35±290.14, p<0.001). Other clinical variables (sex, open-conversion rate, whether the operation was performed at night/holiday, intensive care unit admission rate) did not differ between groups. There was no mortality and readmission.

 Conclusion

The implementation of the ACS led to shorter operation time and no increase of postoperative mortality and complication.

Citations

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  • Laparoscopic Emergency Surgery for Perforated Peptic Ulcer: A Narrative Review
    Jung Min Bae
    Journal of Acute Care Surgery.2025; 15(1): 1.     CrossRef
  • Improved Outcomes in Treating Acute Biliary Disorders With a Shift-Based Acute Care Surgery Model
    Michelle McGill, Chathurika S. Dhanasekara, Beatrice Caballero, Caroline Chung, Adel Alhaj-Saleh, Ariel Santos, Catherine Ronaghan, Sharmila Dissanaike, Robyn Richmond
    The American Surgeon™.2023; 89(5): 1787.     CrossRef
  • Current status of laparoscopic emergency surgery in Korea: multicenter restrospective cohort study
    Jung-Min Bae, Chang-Yeon Jung, Keesang Yoo, Hak-Jae Lee, Suk-Kyung Hong, Sungyeon Yoo, Yun Tae Jung, Eun Young Kim, Min Jung Ko, Ho-Gyun Shin
    Journal of Minimally Invasive Surgery.2023; 26(3): 112.     CrossRef
  • The acute surgical unit: An updated systematic review and meta-analysis
    Ned Kinnear, Samantha Jolly, Matheesha Herath, Jennie Han, Minh Tran, Michael O'Callaghan, Derek Hennessey, Christopher Dobbins, Tarik Sammour, James Moore
    International Journal of Surgery.2021; 94: 106109.     CrossRef
  • The Successful Implementation of a Trauma and Acute Care Surgery Model in Ecuador
    Doris Sarmiento Altamirano, Amber Himmler, Oscar Chango Sigüenza, Raúl Pino Andrade, Nube Flores Lazo, Jeovanni Reinoso Naranjo, Hernán Sacoto Aguilar, Lenin Fernández de Córdova, Edgar Rodas, Juan Carlos Puyana, Juan Carlos Salamea Molina
    World Journal of Surgery.2020; 44(6): 1736.     CrossRef
  • The impact of an acute care surgery model on efficiency and clinical outcomes for patients undergoing appendicectomy in Singapore
    Chun Yuet Khoo, Beatrice Fangju Koh, Amirzeb Aurangzeb, Ryan Bing Qian Lee, Jeremy Chung Fai Ng, Sachin Mathur
    Asian Journal of Surgery.2020; 43(9): 946.     CrossRef
  • Acute Diverticulitis Outcomes in the Acute Care Surgery Model
    Nicholas L. Bandy, Rebecca C. Britt, Sarah C. DeShields, Tina D. Cunningham, L. D. Britt
    Journal of the American College of Surgeons.2018; 226(4): 623.     CrossRef
  • Statewide assessment of surgical outcomes and the acute care surgery model
    Nicholas L. Bandy, Sarah C. DeShields, Tina D. Cunningham, Rebecca C. Britt
    Journal of Surgical Research.2017; 220: 25.     CrossRef
  • 5,439 View
  • 32 Download
  • 8 Crossref
Review Article

Emergency surgery

Ideal Time to Surgery for Acute Abdomen
Maru Kim, Ji Hoon Kim, Sung Jeep Kim, Hang Joo Cho
J Acute Care Surg 2016;6(1):7-10.   Published online April 30, 2016
DOI: https://doi.org/10.17479/jacs.2016.6.1.7

Timing of surgery is important for prognosis. In patients with acute abdomen, the urgency means timing of surgery is even more important. However early emergency surgery is often logistically daunting because of constraints on resources such as operating room, supporting anesthesiologist, and nurses. Therefore it is worthwhile reviewing the timing of surgery in the patient with acute abdomen. The authors discuss the ideal time to surgery based on their experience and a review of the literature. For appendicitis and for peptic ulcer perforation, the authors recommend surgery within 24 hours from symptom onset. However, for other acute abdomen disease, evidence for a consensus is not as strong. If a surgeon faces a large number of emergent patients, if resources are limited, the surgeon must decide priorities for surgery. Therefore, an emergency triage system is needed, based on expert opinion and evidence. Although several triage systems are described in the literature, there is some controversy. If we follow a triage system, utilization of resources will be more efficient and acute care surgery might be performed within the ideal time.

Citations

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  • Integrating acute care surgery in South Korea: enhancing trauma and non-trauma emergency care
    Jin Young Lee, Seheon Kim, Jin Bong Ye, Jin Suk Lee, Younghoon Sul
    World Journal of Emergency Surgery.2025;[Epub]     CrossRef
  • The acute abdomen: Structured diagnosis and treatment
    Nikolaus Börner, Alina-Sophie Kappenberger, Sabine Weber, Florian Scholz, Philipp Kazmierczak, Jens Werner
    Deutsches Ärzteblatt international.2025;[Epub]     CrossRef
  • Time-to-surgery paradigms: wait time and surgical outcomes in critically Ill patients who underwent emergency surgery for gastrointestinal perforation
    Junghyun Lee, Chami Im
    BMC Surgery.2024;[Epub]     CrossRef
  • Pre and postoperative lactate levels and lactate clearance in predicting in-hospital mortality after surgery for gastrointestinal perforation
    Min Kyu Kang, Seung-Young Oh, Hannah Lee, Ho Geol Ryu
    BMC Surgery.2022;[Epub]     CrossRef
  • 6,166 View
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  • 4 Crossref
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