Journal of Acute Care Surgery

Trauma

Traumatic abdominal wall hernia associated with a cow horn in Korea: a case report: Hwajin Shin, Chan Yong Park; J Acute Care Surg 2025;15(2):82-85. Published online July 30, 2025; DOI: https://doi.org/10.17479/jacs.2025.0002

Abstract
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The diagnosis and evaluation of traumatic abdominal wall hernia can be challenging because of its low incidence and nonspecific clinical presentation. Without a high index of clinical suspicion, the detection of traumatic abdominal wall hernia may be delayed. A 71-year-old female patient was struck in the lower abdomen by a cow horn and initially received only conservative management at a local clinic. However, her pain worsened despite conservative measures, and she developed a reducible bulging mass. Computed tomography revealed an abdominal wall defect with small bowel herniation. She was transferred to our hospital's emergency department, where urgent surgery was performed. A laparotomy was conducted to repair the abdominal wall defect and explore potential intra-abdominal injuries. The defect was successfully repaired, and the patient was discharged without complications on postoperative day 10.

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Emergency surgery, Basic

Difficult Small Bowel Bleeding in Surgical View: Jung Min Bae; J Acute Care Surg 2024;14(2):41-44. Published online July 25, 2024; DOI: https://doi.org/10.17479/jacs.2024.14.2.41

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Small bowel bleeding (SBB) accounts for 5%-10% of all gastrointestinal bleeding (GIB) cases. Several diagnostic modalities in SBB are performed. However, the small bowel is beyond the reach of these diagnostic modalities. A large amount of bleeding in GIB is a key factor leading to a poor prognosis. Appropriate and prompt diagnostic and treatment strategies are needed. Several diagnostic and management algorithms have been proposed. However, the processing of algorithm is complex and frequent mistakes are happened. Because of surgical aspects and sudden or gradual development of hemodynamic instability in SBB, algorithms considering surgical role and treatment have been published. The intra-operative enteroscopy (IOE) is a gold-standard method for detecting lesions in SBB. The primary goal of IOE is to detect specific bleeding focus in SBB. The determining the resection range is the secondary goal. In most cases in SBB, segmental resection is treatment of choice. However, in bleeding distal duodenum from distal to the ampulla of Vater to Treitz ligament, pancreas preserving distal duodenectomy could be performed. In terminal ileum bleeding, after resection of pathologic bowel, the reconstruction option is ileo-colic anastomosis or end enterostomy. Because of frequently developed postoperative morbidity and mortality, post-operative critical care is perfectly fit for an acute care surgeon’s role. Therefore, in the entire management process, an interprofessional team or multidisciplinary approach is critical for improving the quality of care of SBB and decreasing mistakes.

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

Spontaneous Rectal Perforation with Transanal Evisceration of the Small Bowel: A Rare Case Report: Ajay Kumar Pal, Prasoon Kumar, Dhirendra Yadav, Awanish Kumar, Harvinder Singh Pahwa, Krishna Kant Singh; J Acute Care Surg 2022;12(2):74-76. Published online July 22, 2022; DOI: https://doi.org/10.17479/jacs.2022.12.2.74

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Transanal evisceration of the small bowel is a rare surgical emergency. Rectal perforation in such cases is usually due to an underlying rectal prolapse. We report a case of a middle aged (45 years) male with spontaneous rectal perforation and transanal evisceration of the small bowel. Approximately 150 cm of small bowel had eviscerated transanally and the patient required emergent abdominal exploration, reposition of the small bowel, and repair of the rectal perforation. Small bowel evisceration through the anal verge is an emergent condition and the aim was to prevent life threatening complications related to sepsis.

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Spontaneous Transanal Small Bowel Evisceration with Distinct CT Findings: A Case Report
Young Min Song, Sung Hwan Bae, Sung Woo Jang
Current Medical Imaging Formerly Current Medical Imaging Reviews.2026;[Epub] CrossRef

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Trauma

Stab Wound Extension for the Eviscerated Small Bowel with Severe Ischemic Changes: Chan Kyu Lee, Chan Yong Park, Kwang Hee Yeo, Ho Hyun Kim; J Acute Care Surg 2018;8(2):71-73. Published online October 30, 2018; DOI: https://doi.org/10.17479/jacs.2018.8.2.71

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An abdominal stab wound with evisceration is an indication of an emergency laparotomy. We encountered a case of a very severe ischemic change in the eviscerated small bowel as a result of stabbing. The patient was considered to have a high possibility of progressing to strangulation of the small bowel. Therefore, a stab wound extension was performed as a decompression in the emergency department before definite surgery in the operating room. Most of the small bowel could be saved except for the segment with the damage caused by the stab injury. The patient was discharged without complications.

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Intestinal Evisceration in Children From the Bite of the Domestic Pig, Sus scrofa domesticus: A Report of Two Cases
Dennis S. Mazingi, Precious Mutambanengwe, Taurai Zimunhu, Tungamirai Gwatirisa, Bothwell A. Mbuwayesango, Kudzayi Munanzvi, Constantine Muparadzi, Mugove Moyo, Yvette Mwanza
Wilderness & Environmental Medicine.2019; 30(4): 454. CrossRef

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Emergency surgery, Trauma

Delayed Pneumatosis Intestinalis Induced by Blunt Trauma in a Strangulated Small Intestine: Dongsub Noh, Hyun Min Cho, Chan-Kyu Lee, Seon Hee Kim, Kwang Hee Yeo; J Acute Care Surg 2017;7(2):83-86. Published online October 30, 2017; DOI: https://doi.org/10.17479/jacs.2017.7.2.83

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An ischemia-reperfusion injury of the intestine due to blunt trauma is very rare. Low blood flow can result in an incarceration and an ischemia-reperfusion injury of the small intestine. A 63-year-old woman fell, producing a splenic rupture. Despite the successful angio-embolization of the splenic rupture, the patient continued to suffer from hypotension. During laparotomy to identify the bowel injury, no intestinal perforation was found. However, we found a hemorrhagic infarction of the small intestine with congestion of the submucosal blood vessels. The part of bowel with the hemorrhagic infarction was resected and reconstructed with a jejuno-colic anastomosis. After surgery, she recovered from the trauma and was discharged without complications. We present this ischemia-reperfusion injury of the intestine due to blunt trauma. Meticulous examination and computed tomography scan is mandatory for diagnosis and assessment of treatment outcome.