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
Pelvis fractures are associated with bladder and urethral injury (BUI). The purpose of this study was to identify risk factors associated with BUI in patients with pelvic fracture.
Methods
Patients (> 18 years) with pelvic injury (N = 314) at our hospital between January 2015 and June 2020 were retrospectively analyzed for age, sex, cause of injury, initial vital signs, urine red blood cell (RBC) count, Glasgow Coma Scale and Abbreviated Injury Scale score, Injury Severity Score, preperitoneal pelvic packing, and femur, lumbar spine, and pelvic fractures.
Results
Compared with the BUI-absent group, the BUI-present group had a greater percentage of patients who were male (79.2% vs. 55.9%; p = 0.026), had a urine RBC count/high power field (HPF) ≥ 30 (94.4% vs. 38.8%; p < 0.001), underwent preperitoneal pelvic packing (37.5% vs. 18.6%; p = 0.035), had symphysis pubis diastasis (33.3% vs. 11.7%; p = 0.008), and had sacroiliac joint dislocation (54.2% vs. 23.4%; p = 0.001). Independent risk factors associated with BUI were symphysis pubis diastasis [odds ratio (OR) was 3.958 (95% confidence interval: 1.191–13.154); p = 0.025] and a urine RBC count/HPF ≥ 30 [OR = 25.415 (95% confidence interval: 3.252–198.637); p = 0.006]. Of those with BUI, 15 patients were diagnosed at the trauma bay, and 9 had a delayed diagnosis.
Conclusion
Patients with pelvic injury who display symphysis pubis diastasis or have a urine RBC count/ HPF ≥ 30 are at higher risk of BUI, therefore, further BUI investigations should be considered.

Citations

• Hematuria as a Screening Tool for Bladder and Urethral Injuries in Pelvic Trauma: A Sensitivity and Specificity Analysis
  Md Habibur Rahman, Muktadir Tamim, Goutom Mukharzi
  TAJ: Journal of Teachers Association.2024; 37(2): 802.     CrossRef

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
Management options for extraperitoneal bladder injury (EBI) associated with pelvic fracture are variable. Predictive factors of operative management (OM) in patients with EBI associated pelvic fracture have not been previously addressed. This study assessed the current epidemiology of blunt traumatic urinary bladder injury and evaluated relevant clinical findings of patients with EBI associated with pelvic fracture who received OM.

Methods
Patients with urinary bladder injury with or without pelvic fracture from blunt trauma from January 1, 2014 to December 31, 2019 were identified from the institute trauma registry (n = 12,891). Demographics, mechanism of injury, type of urinary bladder injury, pelvic fracture configuration, and management options were analysed in the study population (n = 9,894).

Results
Of the 1,400 patients who had pelvic and/or acetabular fracture, 32 (2.3%) had urinary bladder injury. Of the 8,494 patients without pelvic and/or acetabular fracture, 12 (0.1%) had nonpelvic fracture urinary bladder injury. The total incidence of urinary bladder injuries in the study population was 0.4% (44/9,894). Patients with EBI associated with pelvic fracture who underwent OM, had a higher frequency of high-grade pelvic injury (100% vs 0%, p = 0.015), concomitant pelvic surgery (75.0% vs 0%, p = 0.001), and non-lateral compression type pelvic fracture (62.5% vs 10.0%, p = 0.043) compared with patients who underwent non-operative management of EBI.

Conclusions
These data suggest that OM may be considered especially in patients with EBI associated with pelvic fracture with high grade pelvic injury, concomitant pelvic surgery, and nonlateral compression type pelvic fracture.

Citations

• Delayed healing of extraperitoneal bladder rupture after open reduction for pelvic fracture: A case report
  Yu-Cheng Pei, Yeong-Chin Jou
  Tungs' Medical Journal.2025; 19(2): 131.     CrossRef

Purpose

Acute care surgery (ACS) models have evolved worldwide over the last decade. However, South Korea has an established trauma system and does not consider the ACS model. This study compares the management and outcome of emergency cholecystectomy in the ACS model to those of traditional on-call attending surgeon model for emergency surgery.

Methods

Retrospectively collected data for patients who underwent emergency cholecystectomy from May 2013 to January 2015 was analyzed to compare data from a traditional on-call system (OCS) and ACS.

Results

One hundred and twenty-four patients were enrolled in the study (62 patients ACS vs. 62 patients OCS). Hospital stay (days) (ACS=4.29±2.49 vs. OCS=4.82±4.48, p=0.46) and stay in emergency room (minutes) (ACS=213.10±113.99 vs. OCS=241.10±150.73, p=0.20) did not differ significantly between groups. Operation time (minutes) was significantly shorter in the ACS than OCS group (389.97±215.21 vs. 566.35±290.14, p<0.001). Other clinical variables (sex, open-conversion rate, whether the operation was performed at night/holiday, intensive care unit admission rate) did not differ between groups. There was no mortality and readmission.

Conclusion

The implementation of the ACS led to shorter operation time and no increase of postoperative mortality and complication.

Citations

• Laparoscopic Emergency Surgery for Perforated Peptic Ulcer: A Narrative Review
  Jung Min Bae
  Journal of Acute Care Surgery.2025; 15(1): 1.     CrossRef
• Improved Outcomes in Treating Acute Biliary Disorders With a Shift-Based Acute Care Surgery Model
  Michelle McGill, Chathurika S. Dhanasekara, Beatrice Caballero, Caroline Chung, Adel Alhaj-Saleh, Ariel Santos, Catherine Ronaghan, Sharmila Dissanaike, Robyn Richmond
  The American Surgeon™.2023; 89(5): 1787.     CrossRef
• Current status of laparoscopic emergency surgery in Korea: multicenter restrospective cohort study
  Jung-Min Bae, Chang-Yeon Jung, Keesang Yoo, Hak-Jae Lee, Suk-Kyung Hong, Sungyeon Yoo, Yun Tae Jung, Eun Young Kim, Min Jung Ko, Ho-Gyun Shin
  Journal of Minimally Invasive Surgery.2023; 26(3): 112.     CrossRef
• The acute surgical unit: An updated systematic review and meta-analysis
  Ned Kinnear, Samantha Jolly, Matheesha Herath, Jennie Han, Minh Tran, Michael O'Callaghan, Derek Hennessey, Christopher Dobbins, Tarik Sammour, James Moore
  International Journal of Surgery.2021; 94: 106109.     CrossRef
• The Successful Implementation of a Trauma and Acute Care Surgery Model in Ecuador
  Doris Sarmiento Altamirano, Amber Himmler, Oscar Chango Sigüenza, Raúl Pino Andrade, Nube Flores Lazo, Jeovanni Reinoso Naranjo, Hernán Sacoto Aguilar, Lenin Fernández de Córdova, Edgar Rodas, Juan Carlos Puyana, Juan Carlos Salamea Molina
  World Journal of Surgery.2020; 44(6): 1736.     CrossRef
• The impact of an acute care surgery model on efficiency and clinical outcomes for patients undergoing appendicectomy in Singapore
  Chun Yuet Khoo, Beatrice Fangju Koh, Amirzeb Aurangzeb, Ryan Bing Qian Lee, Jeremy Chung Fai Ng, Sachin Mathur
  Asian Journal of Surgery.2020; 43(9): 946.     CrossRef
• Acute Diverticulitis Outcomes in the Acute Care Surgery Model
  Nicholas L. Bandy, Rebecca C. Britt, Sarah C. DeShields, Tina D. Cunningham, L. D. Britt
  Journal of the American College of Surgeons.2018; 226(4): 623.     CrossRef
• Statewide assessment of surgical outcomes and the acute care surgery model
  Nicholas L. Bandy, Sarah C. DeShields, Tina D. Cunningham, Rebecca C. Britt
  Journal of Surgical Research.2017; 220: 25.     CrossRef