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.

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.

Blunt trauma to the abdomen can result in various injuries which are potentially fatal if not promptly recognized and treated. Mechanism of injury, anatomical location, patient demographics, and clinical profile play crucial roles in diagnosis and management. The article presents 2 cases illustrating the challenges, and successful management of isolated jejunal injuries, and highlight the significance of early recognition and surgical intervention. These injuries are rare and there needs to be a high index of suspicion, especially in cases with atypical presentation. The cases in this article underscore the critical role of early surgical intervention in achieving optimal recovery and reducing the morbidity and mortality associated with isolated jejunal injuries. Clinicians need to consider the possibility of small bowel perforation following apparently trivial injuries, and employ a comprehensive approach to managing abdominal trauma.

Pancreatic injury is rare in pediatric cases of blunt abdominal trauma and nonoperative management is preferred in pediatric patients. There are more concerns about operative treatment observed in pediatric patients compared with adult patients. However, some pediatric cases require surgical treatment. If distal pancreatectomy is performed, the necessity of splenectomy should be considered, especially in pediatric patients. This study reports the case of a 17-month-old patient with a Grade 3 pancreatic injury following blunt abdominal trauma. The patient was successfully managed by spleen-preserving distal pancreatectomy. In conclusion, this surgical technique can be performed safely, and complications caused by splenectomy can be prevented using this technique.

Purpose
This study assessed the relationship of core muscle sarcopenia, myosteatosis, and L1 attenuation to the 5-factor modified frailty index (mFI-5), discharge disposition, and post-admission complications in orthopedic and general trauma patients. It was hypothesized that reduced sarcopenia, L1 attenuation, and increased myosteatosis is associated with higher mFI-5 scores (≥ 0.3), discharge into care, and increased post-admission complications.
Methods
This prospective cohort study was performed at a Level 1 trauma center. Patients were surveyed and metrics of the mFI-5 were used. Frail was categorized as a mFI-5 score ≥ 0.3. Recent abdominal computed tomography (CT) scans were used to extract radiographical information of total psoas cross-sectional area, psoas myosteatosis, and L1 vertebrae attenuation.
Results
There were 140 patients who consented to the study, of which 83 had available abdomen and pelvis CT scans. The mean age was 43.19 (± 17.36), and 65% were male (n = 52). When comparing the frail (16%, n = 13) and not frail (84%, n = 70) patients, there was a significant difference in mean psoas myosteatosis (p < 0.0001) and the attenuation of the L1 vertebrae (p < 0.001). On multivariate analysis when accounting for age, myosteatosis of the psoas muscles was predictive of an mFI-5 score ≥ 0.3.
Conclusion
The findings suggest that myosteatosis and L1 attenuation are associated with frailty indices (mFI-5) after traumatic injury. Future studies are needed to prospectively assess the validity of both radiographical and index-based markers of frailty in predicting post-traumatic complications, mortality, and hospital utilization.

Bladder injury is uncommon in blunt abdominal trauma. The injury can be life-threatening if not treated properly. Thus, timely and accurate diagnosis is critical. Traumatic intraperitoneal bladder rupture (TIBR) can be managed laparoscopically in patients who are hemodynamically stable. In this case series, we present 3 patients who underwent laparoscopic repair of TIBR performed by a single surgeon. In addition, we address useful technical tips that would facilitate the generalized use of laparoscopy for treating TIBR.

Citations

• Bladder trauma: a guideline of the guidelines
  Deshin Reddy, Abdullah E. Laher, Maeyane Moeng, Ahmed Adam
  BJU International.2024; 133(4): 365.     CrossRef

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.

Citations

• A Case Study of Acute Appendicitis Improved by Pharmacopuncture Treatment
  Soo-ho Cho, Chul Jung, Keum-ji Kim, Seok-jae Ko, Hwan-su Jung, Jae-woo Park
  The Journal of Internal Korean Medicine.2019; 40(2): 208.     CrossRef