A 78-year-old man developed lower abdominal pain during antibiotic treatment for pneumonia and was admitted to the intensive care unit because of hemodynamic instability. Contrast-enhanced computed tomography revealed edematous changes extending from the ascending colon to the rectum, ascites, and increased density of the surrounding mesenteric fat. Blood tests showed a severe inflammatory response, acute renal failure, and metabolic acidosis, and the patient required continuous vasopressor administration for hemodynamic instability. Clostridioides difficile (CD) antigen and toxin were also detected, leading to a diagnosis of fulminant CD enterocolitis. Because colonic necrosis was suspected, exploratory laparotomy was performed. Operative findings showed no ischemic changes or wall thinning. The colon was preserved, and diverting loop ileostomy with colonic lavage was performed. Although total colectomy is the standard surgical treatment for fulminant CD enterocolitis, this case was successfully managed with ileostomy and colonic lavage.

Postoperative pneumoperitoneum after intraperitoneal procedures, such as laparoscopic surgery, is common and often clinically insignificant because it usually reflects residual free air. In contrast, benign pneumoperitoneum after cardiac surgery is extremely rare and may lead to unnecessary abdominal exploration if it is misinterpreted. We report the case of a 50-year-old woman who developed massive pneumoperitoneum 48 hours after drain removal following uncomplicated coronary artery bypass grafting (CABG). Despite concerning radiographic findings, she remained hemodynamically stable and had a benign abdominal examination. Contrast-enhanced abdominal computed tomography showed no evidence of gastrointestinal perforation. The pneumoperitoneum was attributed to air entry through the drain tract and was managed conservatively, with gradual resolution. Delayed pneumoperitoneum after CABG can occur in the absence of gastrointestinal perforation. Awareness of this rare but benign entity is important to avoid unnecessary surgical intervention.

Penetrating neck trauma involving the aerodigestive tract is a life-threatening emergency. We report a case of an 18-year-old male patient with a zone II cervical wound that caused complete hypopharyngeal transection and a thyroid cartilage fracture. Initial airway control was achieved by direct translaryngeal intubation through the wound, followed by bilateral chest tube placement for pneumothoraces that developed after positive pressure ventilation. Surgical management included tracheostomy, primary hypopharyngeal and laryngeal reconstruction, and vascular control. The postoperative course was complicated by aspiration pneumonia, a strap muscle abscess requiring drainage, opioid withdrawal, and neuroleptic malignant syndrome. Despite these complications, the patient survived and was discharged after approximately 1 month with a gastrostomy tube because of persistent severe dysphagia. This case illustrates the need for flexible airway management, definitive surgical repair, and close postoperative surveillance for complex systemic complications in severe penetrating neck trauma.

Spontaneous intramural small bowel hematoma is a rare complication of anticoagulant therapy that can mimic acute abdomen or mechanical bowel obstruction. This report describes a 66-year-old man with valvular heart disease who was receiving long-term warfarin therapy after surgical aortic valve replacement and presented with diffuse abdominal pain. Computed tomography revealed long-segment bowel wall thickening of the distal jejunum with submucosal edema, findings consistent with an intramural hematoma. During hospitalization, the patient developed a marked hemoglobin decrease, from 13.0 to 6.0 g/dL, along with radiological progression of the hematoma and hemoperitoneum. However, he remained hemodynamically stable and was successfully managed conservatively with bowel rest, intravenous vitamin K, and transfusion of fresh frozen plasma and packed red blood cells. This case suggests that spontaneous intramural small bowel hematoma should be considered in the differential diagnosis of acute abdomen in anticoagulated patients. Even in the presence of severe anemia and hemoperitoneum, conservative management may be safe and effective in hemodynamically stable patients and may help avoid unnecessary surgical intervention.

This case report describes the diagnosis and treatment of a 75-year-old woman who presented to the emergency department with acute abdomen. Preoperative diagnostic evaluation suggested acute acalculous cholecystitis. Because the differential diagnosis included cholecystitis, pancreatitis, gastritis, duodenal ulcer, and other causes of acute abdomen, and because the patient did not respond to conservative management, exploratory laparoscopy was performed. Intraoperatively, gallbladder volvulus with necrosis was identified. Prompt laparoscopic cholecystectomy resolved the patient’s condition and prevented complications such as perforation. This case highlights the importance of timely surgical evaluation and treatment to prevent serious complications, including gangrene and diffuse peritonitis.

The Heimlich maneuver is a useful technique for rescuing patients with airway obstruction, but improper application can cause serious complications. We report a case of a 70-year-old man who underwent the Heimlich maneuver after a food bolus became lodged in his throat while he was eating. Because inappropriate sternal compressions were performed, the obstructing foreign body was not removed at the scene; instead, it was extracted during endotracheal intubation in the emergency department. The patient also developed flail chest as a result of the chest compressions and required conservative management with hospitalization for more than 60 days. This case highlights that caregivers may know of the Heimlich maneuver but may not clearly understand the proper technique. Proper education and training in this lifesaving procedure are therefore essential.

Acute corrosive injury most commonly affects the upper aerodigestive tract and may necessitate emergency surgery in a minority of cases when transmural necrosis develops. The present case manifested with multiorgan dysfunction and subsequently deteriorated, developing acute peritoneal signs that required emergency surgical intervention. Intraoperatively, the distal thoracic esophagus and proximal stomach appeared unexpectedly viable; however, there was extensive transmural circumferential gangrene involving the distal stomach, duodenal C-loop, and proximal jejunum. A surgical decision between pancreatoduodenectomy and pancreas-sparing duodenectomy was required. Given the patient’s poor general condition and hemodynamic instability, pancreas-sparing duodenectomy with ampullo-jejunal anastomosis was performed. Although the postoperative course was complicated, the patient gradually recovered and was discharged on an oral liquid diet. This report outlines the complexities associated with such atypical presentations and emphasizes the importance of individualized surgical decision-making and multidisciplinary postoperative care in the comprehensive management of acute corrosive injuries.

Percutaneous dilatational tracheostomy (PDT) is widely used for prolonged ventilation; however, dilatation-related complications may be underrecognized. We report a complication of tracheostomy malposition induced by tissue stretching during PDT, in which an excessively dilated tract fails to recoil adequately around the tube, compromising the cuff seal. A 57-year-old Korean man was admitted for recurrent seizures. PDT was performed under bronchoscopic guidance without immediate complications. Three days after the first PDT, partial tracheostomy tube dislodgment resulted in a 40%–60% ventilator leak. Sedation, tube reinsertion, and cuff reinflation were attempted; however, the leak worsened to 99%, necessitating rapid sequence intubation. Retrospective review of the bronchoscopic images demonstrated tracheal tissue stretching during initial insertion, suggesting excessive traction on the anterior tracheal wall. A size mismatch between the loading dilator and the tracheostomy tube likely created a gap that allowed tracheal tissue to be drawn into the tract and then recoil, contributing to malposition. Clinicians should recognize this potential complication, monitor for high ventilator leak rates, cuff-pressure abnormalities, and radiographic malalignment, and be prepared to perform repeat tracheostomy or endotracheal intubation if necessary.

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.

Fournier gangrene (FG) is an uncommon but life-threatening condition characterized by rapidly spreading necrotizing fasciitis of the perianal, genital, or perineal regions and accounts for less than 0.02% of hospital admissions, with a reported fatality rate of 20% to 30%. Early diagnosis and prompt multidisciplinary management are essential for achieving optimal outcomes. A 63-year-old man presented with swelling in the right scrotal region. He underwent surgical incision and drainage followed by negative pressure wound therapy. Despite the severity of the presentation, the patient’s prognosis was favorable. This case highlights the risk of misdiagnosing FG in the outpatient setting when initial symptoms resemble benign scrotal conditions and underscores the importance of rapid intervention. The involvement of a clinical pharmacist may enhance patient care by supporting the implementation of an optimized treatment strategy for FG.

Stercoral colitis is a rare but potentially life-threatening condition resulting from chronic constipation and fecal impaction, most often affecting patients with neurologic impairment. We report the case of a 50-year-old paraplegic man with a history of spinal cord injury who developed autonomic dysreflexia and septic shock secondary to a perforated stercoral ulcer within an end colostomy. The patient was admitted for sacral wound reconstruction and initially showed no signs of infection. On postoperative day 3, he decompensated, and imaging revealed pneumoperitoneum and a large fecal burden. Emergent laparotomy identified a stercoral perforation at the colostomy site, and surgical revision of the colostomy was performed. This case illustrates a rare presentation of stercoral perforation in a neurologically compromised patient with a colostomy. Clinicians should maintain a high index of suspicion for stercoral ulceration in patients with spinal cord injury and emphasize preventive bowel care, close monitoring, and timely imaging to reduce morbidity and mortality.

Tuberculosis is known as “the great mimicker.” Extrapulmonary tuberculosis accounts for approximately 20% of all cases, with about 10% of these involving the intestines. The ileocecal region is the most common site due to its high density of lymphoid tissue, slowed intestinal transit, and low bile acid concentration. We report the case of a 16-year-old male student who presented with symptoms consistent with an acute abdomen and required emergency laparotomy; subsequent histological examination confirmed tuberculosis. Diagnosis is challenging because of nonspecific symptoms that mimic other common conditions such as appendicitis. Imaging studies lack specificity, while positive Ziehl-Neelsen staining and the presence of Langerhans-type giant cell granulomas on histologic analysis are among the most sensitive and rapid diagnostic indicators. Intestinal tuberculosis carries a poor prognosis, particularly when associated with complications such as obstruction, perforation, or intestinal stenosis. Medical management follows the same antibiotic regimen used for pulmonary tuberculosis, whereas surgical intervention is reserved for acute abdominal complications.

Retroperitoneal fasciitis is a progressive infection involving the retroperitoneal fascial planes and deeper soft tissues, requiring prompt diagnosis. A 20-year-old man in India with a history of perianal abscess presented with fever, swelling, and severe pain in the abdomen and inguinoscrotal region. Local examination revealed extensive necrotic skin changes involving the perineum and right lumbar region, extending to the scrotum. Contrast-enhanced computed tomography demonstrated a large myocutaneous defect with extensive air foci, fat stranding, and fluid collections in the abdominal wall extending into both retroperitoneal spaces. The patient underwent emergency surgery with debridement of the perineum and right lumbar region. Vacuum-assisted closure therapy and local sump application facilitated rapid and effective wound healing, eliminating the need for reconstruction. This case illustrates successful management of a rare but severe condition.

This report describes a rare case of bilateral foot burns in a 61-year-old man following a religious firewalking ceremony, an event scarcely documented in the literature. The patient presented with multiple painful foot blisters and ulcers 2 days after the ceremony, accompanied by marked discomfort and impaired mobility. On examination, the right foot showed a large deroofed blister with mild slough, whereas the left foot had an intact, tense bleb. The primary diagnosis was bilateral foot burns complicated by diabetes mellitus. Management included deroofing and dressing the right foot blister, while the left foot blister was aspirated, enabling a direct comparison of two treatment strategies within the same patient. Glycemic control was optimized by adjusting insulin dosages, and wound care was tailored to the clinical condition of each foot. Early multidisciplinary consultation guided infection monitoring and pressure offloading. The outcomes underscored the challenges of burn management in diabetic patients, particularly with regard to delayed wound healing and heightened infection risk. This case highlights the importance of individualized burn blister management and the methodological value of comparing deroofing versus aspiration in a controlled clinical context. The key implication is the need for further research to establish best practices for burn care in high-risk populations, especially following unusual injury mechanisms such as firewalking.

Although rubber bullets (RBs) are intended to be nonlethal, they can cause severe injuries under certain circumstances. This case report describes a rare penetrating chest injury in a 21-year-old male soldier who accidentally shot himself at close range with an RB. Upon arrival at the emergency room, computed tomography revealed lung parenchymal injury with hemorrhage and pneumothorax. An emergency thoracotomy with wedge resection was performed to remove the damaged lung tissue and foreign material, namely RB fragments. The soldier recovered and was discharged 17 days after surgery without complications. RBs are radiolucent, making it challenging to determine projectile location and trajectory from imaging alone, which can create a false sense of security regarding the severity of such injuries. Despite their nonlethal classification, RBs can cause fatal injuries; prompt surgical intervention is therefore crucial to achieving a positive outcome.

The literature has described approximately 300 cases of lumbar hernia. Because of its rarity, the condition is often misdiagnosed, leading to delayed treatment. We report the case of a 65-year-old man who had complained for 5 years of a lump in his left lumbar region. There was no history of prior trauma or surgery. The mass gradually increased in size and was associated with vague dragging pain. The diagnosis of Grynfeltt-Lesshaft lumbar hernia was made based on clinical suspicion and ultrasound findings. The patient underwent open sublay mesh repair and recovered without complications. This case is noteworthy for the 5-year delay in diagnosis and management without computed tomography or magnetic resonance imaging, underscoring the role of high clinical suspicion and ultrasound-based diagnosis in resource-limited settings. Although rare, lumbar hernia should be considered in the differential diagnosis of a lumbar mass. Early diagnosis with ultrasound, contrast-enhanced computed tomography, or magnetic resonance imaging can help prevent complications. This case raises awareness of lumbar hernia and outlines available surgical options for treatment.

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.

This case describes a rare but serious complication of endoscopic procedures, highlighting the importance of vigilance in acute care. A 79-year-old man who underwent simultaneous esophagogastroduodenoscopy and colonoscopy developed hemoperitoneum caused by injury to the short gastric artery, a branch of the splenic artery. Emergency angiography demonstrated hypervascularity, and successful hemostasis was achieved using gelfoam embolization. The patient remained stable, with no recurrent bleeding, and was discharged without complications. This case underscores the importance of meticulous procedural technique, comprehensive preprocedural evaluation, and prompt recognition of vascular injury to optimize outcomes in acute care and emergency settings. It also emphasizes the need for continued education and vigilant monitoring to reduce the risk of rare but potentially life-threatening complications in endoscopic practice, in line with the journal’s mission to advance clinical care in trauma and emergency surgery.

We report a rare case of pneumoretroperitoneum caused by a vaginal wall laceration following sexual intercourse, including anal intercourse, in a 19-year-old woman. The patient presented with abdominal pain and syncope. Abdominal computed tomography revealed free air in the retroperitoneal space, initially raising suspicion for rectal perforation. However, intraoperative colonoscopy confirmed the rectum was intact. A subsequent gynecological examination identified a 4-cm laceration in the lateral fornix that directly communicated with the retroperitoneal space. The injury was surgically repaired, and the patient achieved a full recovery without complications. This case underscores the importance of considering vaginal trauma in the differential diagnosis of pneumoretroperitoneum, particularly in sexually active young women. A prompt gynecological evaluation can prevent misdiagnosis and unnecessary interventions. In stable patients without signs of infection or peritonitis, conservative management following surgical repair may suffice. To our knowledge, this is the first reported case of pneumoretroperitoneum following sexual intercourse in the absence of rectal injury.

Although liver lacerations are relatively common following blunt trauma, hepatic artery injuries are rare, with only a few cases of hepatic artery dissection caused by blunt trauma reported to date. Due to its rarity, no standardized treatment protocol exists for managing such injuries. We report the case of a 22-year-old female patient referred with a suspected pancreatic injury and liver laceration following blunt trauma. Upon arrival, she presented severe abdominal pain, and a physical examination revealed significant epigastric tenderness. Emergency laparotomy confirmed pancreatic contusion and liver laceration, for which peritoneal irrigation and wide drainage were performed. On postoperative day 17, hepatic artery dissection was incidentally diagnosed with computed tomography, although the patient remained asymptomatic and laboratory tests were within normal limits. Conservative management with an antiplatelet agent was initiated. A follow-up computed tomography scan performed 4 months post trauma demonstrated complete resolution of hepatic artery dissection.

Resuscitative endovascular balloon occlusion of the aorta (REBOA) is an emerging intervention for noncompressible torso hemorrhage. We report the case of a 64-year-old man who presented with abdominal pain and hypotension due to a ruptured abdominal aortic aneurysm in South Korea. Upon clinical deterioration, temporary aortic occlusion was achieved using antegrade REBOA via the left brachial artery in the operating room. A balloon catheter was successfully placed proximal to the aneurysm using the Seldinger technique, resulting in rapid stabilization of vital signs. Definitive surgical repair with aortic replacement was then performed without complications. The patient fully recovered and was discharged 1 month later. This case demonstrates the clinical utility of antegrade REBOA when retrograde insertion is contraindicated, particularly in juxtarenal aneurysms. REBOA can provide a critical window for hemodynamic stabilization and surgical control in cases of life-threatening hemorrhage. Careful consideration of access site, balloon positioning, and imaging guidance is essential for safely and effectively deploying this technique.

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.

The A-1000 (Elmeca, Co. Ltd., Seoul, Korea) electrical automatic airway suction device, was designed to operate as a customizable repeated closed suction device. It can be used for patients with intubation or tracheostomy tubes. This is the first recorded case of the use of the A-1000 in a general ward patient with a tracheostomy tube. A 91-year-old man presented having attempted suicide by hanging and was admitted to this institution. Although extubation was performed in the intensive care unit, the patient required 2 reintubations. The tracheostomy was performed, and the A-1000 was applied. After weaning from mechanical ventilation, the patient was transferred to the General Ward with a tracheostomy tube in place for effective removal of sputum by the A-1000. The tracheostomy tube was successfully removed, and the patient was discharged. The effectiveness and safety of the A-1000 needs further study by expanding the applications of this device.