Journal of Acute Care Surgery

Pediatric abdominal tuberculosis presenting as an acute surgical abdomen in a 16-year-old male patient from Colombia: a case report: Alejandro Rojas-Urrea, Daniela Arias-Mariño, Ana María Rojas-Faura, Mónica Liseth Holguín-Barrera, Lorena Garcia-Agudelo; J Acute Care Surg 2025;15(3):143-147. Published online November 30, 2025; DOI: https://doi.org/10.17479/jacs.2025.0025

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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.

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Others, Organ(liver, bowel, kideny etc.)

Pneumoretroperitoneum mimicking rectal perforation, secondary to vaginal wall laceration following sexual intercourse in a 19-year-old woman in Korea: a case report: Sung Pil Choo, Ki Eun Seon, Jae Cheol Jung, Kyeong Deok Kim, Moon Suk Choi; J Acute Care Surg 2025;15(2):86-89. Published online July 30, 2025; DOI: https://doi.org/10.17479/jacs.2025.0011

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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.

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

Ruptured Splenic Abscess with Pneumoperitoneum: A Rare Presentation: Gurleen Kaur, Tanya Singh, Shivani Goyal, Robin Kaushik, Simrandeep Singh; J Acute Care Surg 2023;13(3):138-140. Published online November 23, 2023; DOI: https://doi.org/10.17479/jacs.2023.13.3.138

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Splenic abscess is a rare entity encountered during clinical practice, with a high mortality rate. Formation of gas in splenic abscess is usually localized to the left upper quadrant of the abdomen. Here we report a case where the splenic abscess ruptured and presented with generalized peritonitis. The erect chest radiograph showed free air under the right dome of the diaphragm, thus masquerading a hollow viscera perforation (most common cause of pneumoperitoneum).

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Pneumoperitoneum Caused by a Ruptured Splenic Abscess Mimicking Gastrointestinal Perforation: A Case Report
Naoki Kawahara, Mitsuaki Kojima, Koji Morishita
Surgical Case Reports.2025; 11(1): n/a. CrossRef
Ruptura espontânea de abscesso esplênico simulando perfuração de víscera oca: relato de caso e revisão da literatura
Marcos Duarte Guimarães, Priscylla Pereira Medeiros Leite, Priscila Ribeiro de Amorim Martins, Daniel Maxwell dos Santos Souza
Journal Archives of Health.2025; 6(5): e3641. CrossRef

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Emergency surgery

Intra-Abdominal Explosion due to Pneumoperitoneum Following Colon Perforation: Sang Bong Lee; J Acute Care Surg 2020;10(1):30-32. Published online March 30, 2020; DOI: https://doi.org/10.17479/jacs.2020.10.1.30

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Explosions in the abdomen during surgery are rare. This article reports a case of an intra-abdominal explosion caused by flammable gas ignited by electrocautery during a laparotomy. The patient’s small intestine, left colon, and peritoneum were burned superficially, but recovered without any specific symptoms. Despite the rarity of this phenomenon, surgeons should be aware of the possibility of an explosion due to intra-abdominal gas, and consider the use a scalpel rather than electrocautery when opening the peritoneum of patients with pneumoperitoneum.

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Trauma, Others

Pneumoperitoneum from Subcutaneous Emphysema after Blunt Chest Injury: Byung Hee Kang, Jonghwan Moon; J Acute Care Surg 2017;7(1):30-33. Published online April 30, 2017; DOI: https://doi.org/10.17479/jacs.2017.7.1.30

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Pneumothorax and pneumomediastinum can cause pneumoperitoneum, which does not require surgery. There are unverified theories pertaining to how air passes through the diaphragm. We report a case of pneumoperitoneum caused by blunt chest injury that was successfully managed with conservative care. Although the pneumoperitoneum was caused by thoracic injury, we believe that the air did not pass through the diaphragm, but instead came from the abdominal wall, as in subcutaneous emphysema

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Citations to this article as recorded by

Pneumoperitoneum without significant bowel perforation in patients with blunt trauma: a systematic review and meta-analysis
Emad Masuadi, Yasir Ahmed Mohammed Elhadi, Osman S. Abdelhamed, Zainab M. Alkharas, Linda Östlundh, Gamila Ahmed, Ashraf F. Hefny
World Journal of Emergency Surgery.2026;[Epub] CrossRef