Journal of Acute Care Surgery

Computed tomography-based triage and outcomes of a dedicated COVID-19 Emergency Surgical Team (CEST) for suspected acute abdomen in a Korean COVID-19 base hospital: a retrospective cohort study: Jun Hyung Kim, Sungho Lee, Kwanhoon Park, Kang Yoon Lee, Da Hyun Jung, Il Jo, Hangil Yun, Ji Young Jang; J Acute Care Surg 2026;16(1):31-41. Published online March 31, 2026; DOI: https://doi.org/10.17479/jacs.2025.0020

Purpose
The COVID-19 pandemic significantly disrupted surgical services and necessitated the development of new clinical protocols. National Health Insurance Service Ilsan Hospital in Korea established a COVID-19 Emergency Surgical Team (CEST) to manage surgical cases and optimize medical staff utilization, thereby ensuring timely care during the pandemic. This study describes our experience with the CEST and highlights its potential role in institutional preparedness for future public health crises.
Methods
Between December 19, 2020, and April 4, 2022, this study included patients with laboratory-confirmed COVID-19 who were hospitalized at National Health Insurance Service Ilsan Hospital, a designated COVID-19 treatment center in Korea. Among these patients, those who underwent abdominopelvic computed tomography (APCT) were selected for analysis, and the indications for APCT were categorized. Patients specifically evaluated for suspected surgical abdomen were identified for subgroup analysis.
Results
Among 90 patients who underwent APCT, 32 (36.0%) were evaluated for suspected acute abdomen requiring urgent attention; 25 (28.1%) for persistent fever or elevated inflammatory markers; 15 (16.9%) for acute kidney injury; and 7 (7.9%) for liver enzyme elevation. Compared with the remaining 3,765 patients, the 32 patients with suspected surgical abdomen were significantly older and had longer hospital stays, higher rates of intensive care unit admission, and greater use of high-flow nasal cannula, dexamethasone, and antibiotics. Initial laboratory findings demonstrated higher white blood cell count, ferritin, creatinine, bilirubin, and D-dimer levels in this group. This case series underscores the role of the CEST in managing surgical patients with COVID-19.
Conclusion
We describe our institutional experience with the CEST and emphasize how the lessons learned may inform preparedness for future public health emergencies. This model may serve as a practical framework for managing surgical care during similar crises.

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Hidden risk of euglycemic diabetic ketoacidosis with sodium-glucose cotransporter 2 (SGLT2) inhibitors in emergency general surgery in the United States: a case report: Laura Roberson, June Yao, Christina So, Brian Tuai; J Acute Care Surg 2026;16(1):70-74. Published online March 26, 2026; DOI: https://doi.org/10.17479/jacs.2025.0021

Abstract
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Understanding empagliflozin use during the perioperative period is crucial for improving outcomes, given the increasing use of sodium- glucose cotransporter 2 (SGLT2) inhibitors and the growing population of surgical patients with diabetes. A 62-year-old woman with poorly controlled type 2 diabetes (hemoglobin A1c, 11.9%), obesity, coronary artery disease, and prior euglycemic diabetic ketoacidosis (euDKA) was taking empagliflozin and insulin when she presented with acute cholecystitis. Initial evaluation demonstrated tachypnea and mild metabolic acidosis with near-normal glucose levels. While kept nothing by mouth and resuscitated with normal saline and sliding-scale insulin, she developed severe high–anion-gap metabolic acidosis (pH, 7.1) with marked ketosis and mild hyperglycemia within 6 hours, consistent with euDKA, requiring intensive care. Treatment with intravenous insulin, dextrose-containing fluids, and bicarbonate resolved the anion gap by hospital day 3, permitting an uncomplicated laparoscopic cholecystectomy. On postoperative day 1, euDKA recurred (pH, 7.2; glucose, 76 mg/dL) and responded to the same protocol with endocrinology-guided insulin adjustment. In urgent surgical settings, clinicians should discontinue SGLT2 inhibitors immediately, initiate early glucose-containing fluids and insulin therapy, and monitor ketones and acid-base status—even in the setting of normal glucose—to prevent delayed diagnosis. Increased awareness may assist providers who manage such patients and may reduce complications and morbidity in the acute care setting.

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New-onset autoimmune diabetes and fatal pathologic pneumatosis after recent durvalumab lung cancer treatment in the United States: a case report: Lauren R. Moore, Manuel Martinez; J Acute Care Surg 2026;16(1):75-78. Published online March 23, 2026; DOI: https://doi.org/10.17479/jacs.2025.0033

Abstract
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A 66-year-old man presented with diabetic ketoacidosis due to new-onset type 1 diabetes mellitus following recent immunotherapy with durvalumab for lung cancer. Imaging revealed incidental pneumatosis intestinalis and elevated lactate levels in the setting of a benign abdominal examination. Mesenteric ischemia was later confirmed during surgical exploration, necessitating multiple operations and repeat bowel resections. The bowel was left in discontinuity with temporary abdominal closure, and the patient was admitted to the intensive care unit. Ultimately, the course was fatal due to insufficient viable bowel length to sustain life. This case highlights two rare but critical immune-mediated adverse effects likely associated with the recent initiation of durvalumab, a programmed death ligand 1 (PDL1) inhibitor, for lung cancer treatment. The development of new autoimmunity or coagulopathy in patients recently treated with PD-L1 immunotherapy for cancer should prompt consideration of a potential causal relationship and early multidisciplinary discussion involving surgery and hematology-oncology.

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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

Abstract
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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.

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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

Abstract
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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.

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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

Abstract
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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
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