Journal of Acute Care Surgery

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

Abstract
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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.

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Basic, Infection/Sepsis

Thromboelastographic Evaluation in Patients with Severe Sepsis or Septic Shock: A Preliminary Analysis: Sokyung Yoon, JooYen Lim, Chi-Min Park, Dae-Sang Lee, Jae Berm Park, Kyoungjin Choi, Keesang Yoo, Eunmi Gil, Kyoung Won Yoon; J Acute Care Surg 2020;10(2):47-52. Published online July 24, 2020; DOI: https://doi.org/10.17479/jacs.2020.10.2.47

Abstract
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Purpose
Thromboelastography (TEG) was investigated for the diagnosis of coagulopathy compared with traditional coagulation tests, in association with disease severity in patients with severe sepsis or septic shock.
Methods
Retrospective data was collected from a single center between January 25th to March 24th, 2016. There were 18 patients with severe sepsis or septic shock admitted to intensive care units included in this study. Laboratory tests including TEG were performed at admission. Disease severity was measured using the Simplified Acute Physiology Score III, Sequential Organ Failure Assessment score, and the level of lactate.
Results
There were 18 patients (61% males; median age, 60.5 years) who were diagnosed with severe sepsis, or septic shock requiring a norepinephrine infusion (n = 10, 55.6%). Of these, 4 patients had traditional coagulation tests, and TEG profiles which confirmed hypercoagulability. Eight patients had follow-up tests 48 hours post-admission with a Sequential Organ Failure Assessment score of 6.5 (3-9.5) at admission, decreasing to 4 (2-11) after 48 hours (although not significantly lower), however, the lactate level decreased statistically significantly from 2.965 at admission, to 1.405 mmol/L after 48 hours (p < 0.05). The TEG profiles tended to normalize after 48 hours compared with admission, but there was no statistically significant difference.
Conclusion
Coagulopathy with severe sepsis or septic shock patients can be life-threatening, therefore it is important to diagnose coagulopathy early and precisely. TEG can be a feasible tool to confirm coagulopathy with traditional coagulation tests.

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Fluid/Hemodymics, Critical care

Resuscitation Fluid Use in a Single Surgical Intensive Care Unit: Yong Dae Lee, Jeong-Am Ryu, Dae-Sang Lee, Jinkyeong Park, Joongbum Cho, Chi Ryang Chung, Yang Hyun Cho, Jeong Hoon Yang, Gee Young Suh, Chi-Min Park; J Acute Care Surg 2020;10(1):18-24. Published online March 30, 2020; DOI: https://doi.org/10.17479/jacs.2020.10.1.18

Abstract
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Purpose
The aim of this study was to analyze the temporal change of resuscitation fluid use based on all fluids administered in a surgical intensive care unit (ICU).
Methods
The administration of resuscitation fluid to all patients admitted to a surgical ICU of a tertiary referral hospital was investigated from 2008 to 2015. The types and volumes of fluid, and laboratory data taken within 7 days after ICU admission were evaluated. Resuscitation fluids were defined as fluids infused according to stat orders, rather than routine orders.
Results
There were a total of 8,885 admissions to the ICU for 7,886 patients. The volumetric proportion of crystalloid to total resuscitation fluids increased significantly over the study period (p < 0.001; 79.6% in 2008; 93.7% in 2015). Although the proportion of 0.9% saline to crystalloids decreased, that of balanced solutions increased (p < 0.001; 29.5% in 2008; 55.6% in 2015). The use of colloids decreased from 20.4% in 2008, to 6.3% in 2015 (p < 0.001). Proportions calculated using the number of individual fluids administered revealed trends similar to those calculated using volumetric data. The amount of infused 0.9% saline was weakly correlated with the lowest blood pH and the highest serum chloride levels (ρ = -0.26 and 0.19, respectively).
Conclusion
Changes in the trends of fluid resuscitation practice were noted in a single surgical ICU over the 8-year study period. Crystalloid use increased owing to a rise in the utilization of balanced solutions with a downward trend in colloid use.

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Critical care

Clinical Significance of Creatine Kinase Elevation in Critically Ill Patients: Chi-Woo Lee, Seung-Wook Choi, Dae-Sang Lee, Eunmi Gil, Chi-Min Park; J Acute Care Surg 2018;8(1):13-18. Published online April 30, 2018; DOI: https://doi.org/10.17479/jacs.2018.8.1.13

Abstract
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Purpose:

Creatine kinase (CK) elevation is caused by rhabdomyolysis, intense exercise, muscle damage, and several drugs. This study evaluated the clinical significance of elevated serum CK levels in patients with an intensive care unit (ICU) and their effects on muscle strength.

Methods:

The database of 179 patients, who were examined with CK at least once among patients in the Samsung Medical Center ICU database, was reviewed retrospectively. Forty- eight patients with a myocardial infarction were excluded and 131 patients were analyzed. The clinical features of patients with an elevated CK of more than 2,000 IU/L (more than 10 times the normal value) and those who did not were compared.

Results:

The ICU stay days were longer in the high elevation group than the other group (8.6 days vs. 21.7 days, p=0.002). The high elevation group was more likely to go to other treatment centers than home after discharge (14.6% vs. 60.0%, p=0.007). When the Medical Research Council scale was measured, the score of the high elevation group was lower than that of the other group (17.2 vs. 13.3, p=0.006).

Conclusion:

Patients with high CK levels were more likely to receive invasive treatment in the ICU, so their muscle strength may decrease with increasing ICU stay and were less likely to be discharged home because of difficulties in living alone. Therefore, in patients with high CK, anticipating long-term treatment in an ICU, minimizing muscle loss, and maintaining functional muscle strength through active rehabilitation will be helpful for the prognosis of the patient.

Citations

Citations to this article as recorded by

Creatine Kinase as a Prognostic Factor for Mortality in Extracorporeal Cardiopulmonary Resuscitation: A Retrospective Observational Study
Dong Ki Kim, Byeong Jo Chun, Yeon Ji Seong
Journal of Clinical Medicine.2025; 14(23): 8404. CrossRef

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Basic, Critical care

Prevalence of Multidrug Resistant Organisms in Inter-Hospital Transferred Critically Ill Patients: Changho Heo, Dae-Sang Lee, Eunmi Gil, Chi-Min Park; J Acute Care Surg 2017;7(1):9-14. Published online April 30, 2017; DOI: https://doi.org/10.17479/jacs.2017.7.1.9

Abstract
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Purpose:

To assess the prevalence of multidrug-resistant organisms (MDROs) in inter-hospital transferred critically ill patients.

Methods:

This is a retrospective study. The study population comprised patients who were transferred from other hospitals or health care units into the medical or surgical intensive care unit of Samsung Medical Center from January 2012 to December 2014. We evaluated the acquisition of clinically significant MDROs including methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococci (VRE), extended-spectrum beta-lactamase (ESBL)-producing Gram-negative bacteria, and carbapenem-resistant Gram-negative bacteria (CRGNB).

Results:

Three hundred and twenty-one patients were included in this study. One hundred and fifty-one patients (47.0%) had at least one species of MDRO, 21.5% in MRSA, 27.1% in VRE, 15.6% in CRGNB, and 3.7% in ESBL. The prevalence of MDROs was significantly higher in male (52.7%), patients with diabetes (61.6%), patients with combined infectious diseases (51.6%), and medical patients (49.3%). Patients with MRSA had significantly longer length of stay than the patients without MRSA. The patients with CRGNB had higher mortality than the patients without CRGNB.

Conclusion:

The prevalence of MDROs in inter-hospital transferred critically ill patients was very high. Patients with MDROs in this study had longer hospital stay and higher mortality. These patients require more attention for isolation and hygiene protocols, and antibiotic choices.

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Fluid/Hemodymics

Effect of a Saline on Acute Kidney Injury among Patients inthe Intensive Care Unit: Dae-Sang Lee, Chi-Min Park; J Acute Care Surg 2016;6(1):42-43. Published online April 30, 2016; DOI: https://doi.org/10.17479/jacs.2016.6.1.42

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Trauma

Delayed Traumatic Carotid-Cavernous Sinus Fistula Accompanying Intracranial Hemorrhage: Tae Sun Ha, Chi-Min Park, Dae-Sang Lee, Jeong-Am Ryu, Chi Ryang Chung, Jeong Hoon Yang, Kyeongman Jeon, Gee Young Suh; J Acute Care Surg 2016;6(1):29-33. Published online April 30, 2016; DOI: https://doi.org/10.17479/jacs.2016.6.1.29

Abstract
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Traumatic carotid-cavernous fistula (TCCF) is a pathologic communication between the internal carotid artery and cavernous sinus, and is associated with craniomaxillofacial trauma. TCCF are very rare, occurring in 0.17∼0.27% of craniomaxillofacial trauma cases. We describe a 76-year-old woman treated for multiple fractures including the skull base, left temporal bone, right tibia and fibula, left clavicle, and fifth and seventh rib fractures. She developed symptoms of TCCF two weeks after the initial trauma. We successfully treated her by endovascular occlusion of the internal carotid artery.