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.

Purpose
Several studies have reported venous thromboembolism after COVID-19. This association raises the possibility that the incidence of ischemic enterocolitis (IE) may have increased during the COVID-19 pandemic. This study aimed to identify changes in the incidence of IE using the National Health Insurance Service (NHIS) database in Korea and to assess the clinical impact of COVID-19.
Methods
Using the NHIS data from 2016 to 2022, we identified 2,637 patients who underwent surgery after a diagnosis of IE. The primary endpoint was the annual incidence of IE and whether this incidence changed during the COVID-19 period.
Results
The incidence per million population was calculated using the total population of Korea as the denominator. The annual incidences of IE from 2016 to 2022 were 6.56, 6.76, 6.98, 7.73, 7.35, 8.08, and 7.65 per million population, respectively. Poisson regression showed an annual increase in IE incidence (incidence rate ratio [IRR], 1.044; 95% confidence interval [CI], 1.004–1.085; P=0.029), whereas the COVID-19 period was not associated with a significant change in IE incidence (IRR, 0.945; 95% CI, 0.811–1.103; P=0.475).
Conclusion
The incidence of IE increased significantly over time, but no significant increase was observed during the COVID-19 period.

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

• Laparoscopic repair of urinary bladder ruptures in cattle
  Ersin Tanriverdi, Özgür Aksoy, Mert Sezer
  The Veterinary Journal.2026; 318: 106785.     CrossRef
• 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

• Thoracic Packing Failure due to Occult Diaphragmatic Injury after Empyema Surgery
  Makoto Tatsumi, Tomonari Oki, Shuhei Iizuka, Toru Nakamura
  Surgical Case Reports.2026; 12(1): n/a.     CrossRef

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