Pub Date : 2022-11-30DOI: 10.17479/jacs.2022.12.3.120
G. Kim, Jae Hun Kim, Hohyun Kim, Seon Hee Kim, Sung Jin Park, Sang Bong Lee, C. Park, Dongyeon Ryu, K. Lee, S. Kim, N. Lee, I. Wang
Purpose: A trauma center project for treating patients with trauma has been established in Korea. A trauma team is activated based on the Centers for Disease Control and Prevention (CDC) field triage Step 1 for patient triage. Here, we determined if the currently applied criteria were appropriate for the triage of patients with trauma in Korea.Methods: This retrospective study included patients who were taken to the regional trauma center from January 1, 2016 to December 31, 2019, and were registered in the Korean Trauma database. The rates for undertriage and overtriage were calculated from the in-field and in-hospital triage according to the CDC guidelines Step 1.Results: Among the 9,383 patients transferred to the trauma center, 3,423 were directly transferred from the site and were investigated. The overall rates for undertriage and overtriage of these patients were 28.13% and 30.35%, respectively. For the patients who received in-field triage and were directly transferred to the trauma center, the rates for undertriage and overtriage were 27.92% and 32.39%, and 25.92% and 29.11% for in-hospital triage, respectively. The concordance rate of triage was 87.09%.Conclusion: The current use of in-hospital triage physiological criteria as set out in the CDC guidelines Step 1, indicated an undertriage rate which was high and an overtriage rate within the acceptable range. Further studies on triaging patients with trauma are warranted. Improvements in the guidelines of the trauma center project are necessary and this needs to be supported by resources and training for field personnel.
{"title":"Assessment of the Suitability of Trauma Triage According to Physiological Criteria in Korea","authors":"G. Kim, Jae Hun Kim, Hohyun Kim, Seon Hee Kim, Sung Jin Park, Sang Bong Lee, C. Park, Dongyeon Ryu, K. Lee, S. Kim, N. Lee, I. Wang","doi":"10.17479/jacs.2022.12.3.120","DOIUrl":"https://doi.org/10.17479/jacs.2022.12.3.120","url":null,"abstract":"Purpose: A trauma center project for treating patients with trauma has been established in Korea. A trauma team is activated based on the Centers for Disease Control and Prevention (CDC) field triage Step 1 for patient triage. Here, we determined if the currently applied criteria were appropriate for the triage of patients with trauma in Korea.Methods: This retrospective study included patients who were taken to the regional trauma center from January 1, 2016 to December 31, 2019, and were registered in the Korean Trauma database. The rates for undertriage and overtriage were calculated from the in-field and in-hospital triage according to the CDC guidelines Step 1.Results: Among the 9,383 patients transferred to the trauma center, 3,423 were directly transferred from the site and were investigated. The overall rates for undertriage and overtriage of these patients were 28.13% and 30.35%, respectively. For the patients who received in-field triage and were directly transferred to the trauma center, the rates for undertriage and overtriage were 27.92% and 32.39%, and 25.92% and 29.11% for in-hospital triage, respectively. The concordance rate of triage was 87.09%.Conclusion: The current use of in-hospital triage physiological criteria as set out in the CDC guidelines Step 1, indicated an undertriage rate which was high and an overtriage rate within the acceptable range. Further studies on triaging patients with trauma are warranted. Improvements in the guidelines of the trauma center project are necessary and this needs to be supported by resources and training for field personnel.","PeriodicalId":34662,"journal":{"name":"Journal of Acute Care Surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44336964","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-11-30DOI: 10.17479/jacs.2022.12.3.103
B. Kang, K. Jung, H. Shim, D. H. Kim
Purpose: In the Republic of Korea, the use of trauma centers was recently adopted and is expected to have better outcome for severely injured patients. This study aimed to evaluate the clinical outcomes and treatment methods for unstable pelvic bone fractures in trauma centers. Methods: The annual number of patients, clinical outcomes, and treatment methods of unstable pelvic bone fractures in three trauma centers from 2016 to 2020 were retrospectively reviewed. The patients were dichotomized into survivors and deceased, and demographic data, treatment, and clinical outcomes were compared. Multivariable analysis was performed to identify the factors associated with survival.Results: Among 237 patients, 101 (42.6%) were deceased. Mortality was lower in the later period (2019- 2020) compared with the early period (2016-2018; 33.6% vs. 50.0%, p = 0.011). Direct admission of an increasing number of patients to trauma centers reduced prehospital time. Although the use of angioembolization in treating pelvic bone fracture (p < 0.001), and the use of other treatment methods did not change significantly (2016-2020). Lower age, lowest systolic blood pressure in the trauma bay, and higher lactate level, international normalized ratio, the amount of packed red blood cell transfusion at 24 hours were positively associated with mortality in the multivariate analysis.Conclusion: Increasingly more patients with unstable pelvic bone fracture were admitted to trauma centers; mortality improved. Angioembolization increased significantly and multi-disciplinary modality for early bleeding control was still essential.
目的:在大韩民国，创伤中心的使用最近被采用，预计对严重受伤的患者有更好的结果。本研究旨在评估创伤中心不稳定骨盆骨折的临床结果和治疗方法。方法:回顾性分析2016 - 2020年三家创伤中心每年收治不稳定骨盆骨折的患者数量、临床结局及治疗方法。将患者分为幸存者和死者，比较人口统计数据、治疗和临床结果。进行多变量分析以确定与生存相关的因素。结果:237例患者中，101例(42.6%)死亡。与早期(2016-2018年)相比，后期(2019- 2020年)死亡率较低;33.6% vs. 50.0%， p = 0.011)。越来越多的病人直接进入创伤中心减少了院前时间。虽然使用血管栓塞治疗盆腔骨折(p < 0.001)，但其他治疗方法的使用没有明显变化(2016-2020)。多因素分析显示，年龄较低、创伤区收缩压最低、较高的乳酸水平、国际标准化比率、24小时红细胞输血量与死亡率呈正相关。结论:越来越多的不稳定骨盆骨折患者被送往创伤中心;死亡率提高。血管栓塞明显增加，多学科的早期出血控制模式仍然是必要的。
{"title":"Management Trend for Unstable Pelvic Bone Fractures in Regional Trauma Centers: Multi-Institutional Study in the Republic of Korea","authors":"B. Kang, K. Jung, H. Shim, D. H. Kim","doi":"10.17479/jacs.2022.12.3.103","DOIUrl":"https://doi.org/10.17479/jacs.2022.12.3.103","url":null,"abstract":"Purpose: In the Republic of Korea, the use of trauma centers was recently adopted and is expected to have better outcome for severely injured patients. This study aimed to evaluate the clinical outcomes and treatment methods for unstable pelvic bone fractures in trauma centers. Methods: The annual number of patients, clinical outcomes, and treatment methods of unstable pelvic bone fractures in three trauma centers from 2016 to 2020 were retrospectively reviewed. The patients were dichotomized into survivors and deceased, and demographic data, treatment, and clinical outcomes were compared. Multivariable analysis was performed to identify the factors associated with survival.Results: Among 237 patients, 101 (42.6%) were deceased. Mortality was lower in the later period (2019- 2020) compared with the early period (2016-2018; 33.6% vs. 50.0%, p = 0.011). Direct admission of an increasing number of patients to trauma centers reduced prehospital time. Although the use of angioembolization in treating pelvic bone fracture (p < 0.001), and the use of other treatment methods did not change significantly (2016-2020). Lower age, lowest systolic blood pressure in the trauma bay, and higher lactate level, international normalized ratio, the amount of packed red blood cell transfusion at 24 hours were positively associated with mortality in the multivariate analysis.Conclusion: Increasingly more patients with unstable pelvic bone fracture were admitted to trauma centers; mortality improved. Angioembolization increased significantly and multi-disciplinary modality for early bleeding control was still essential.","PeriodicalId":34662,"journal":{"name":"Journal of Acute Care Surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43428446","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-11-30DOI: 10.17479/jacs.2022.12.3.91
Sung-Bae Lee, K. Park, K. Lee, J. Jang
The demand for hospitalists is increasing due to decreasing numbers of clinical residents and increased concerns regarding patient safety. However, several limitations in the surgical hospitalist role exist. The personnel of the surgical hospitalist, rapid response team (RRT), surgical critical care, and trauma surgery teams were unified under the admission, critical care, and trauma surgery (ACTs) team at this institution. The ACTs target are patients with severe disease not undergoing general postoperative course, or patients with the potential for severe conversion. Two surgical intensivists are on duty once a week and oversee the intensive care unit (ICU), the back-up treatment of critically ill patients, and the immediate treatment of trauma patients. ACTs also participate in the surgical RRT and select patients with a high probability of severe exacerbation. Between 2019-2021, the cardiopulmonary resuscitation incidence per 1,000 hospitalized patients in the surgical department decreased significantly from 0.81 to 0.55. From March to December 2021, the ACTs team were involved with 101 of 158 surgical patients admitted to the ICU: 62 with postoperative status, 29 with severe trauma, and 10 transferred to the ICU via RRT screening. Based on our experience, the role of the ACTs team can help improve patient safety.
{"title":"New Concept of a Surgical Hospitalist: Early Experience of Managing the Admission, Critical Care, Trauma Surgery Team","authors":"Sung-Bae Lee, K. Park, K. Lee, J. Jang","doi":"10.17479/jacs.2022.12.3.91","DOIUrl":"https://doi.org/10.17479/jacs.2022.12.3.91","url":null,"abstract":"The demand for hospitalists is increasing due to decreasing numbers of clinical residents and increased concerns regarding patient safety. However, several limitations in the surgical hospitalist role exist. The personnel of the surgical hospitalist, rapid response team (RRT), surgical critical care, and trauma surgery teams were unified under the admission, critical care, and trauma surgery (ACTs) team at this institution. The ACTs target are patients with severe disease not undergoing general postoperative course, or patients with the potential for severe conversion. Two surgical intensivists are on duty once a week and oversee the intensive care unit (ICU), the back-up treatment of critically ill patients, and the immediate treatment of trauma patients. ACTs also participate in the surgical RRT and select patients with a high probability of severe exacerbation. Between 2019-2021, the cardiopulmonary resuscitation incidence per 1,000 hospitalized patients in the surgical department decreased significantly from 0.81 to 0.55. From March to December 2021, the ACTs team were involved with 101 of 158 surgical patients admitted to the ICU: 62 with postoperative status, 29 with severe trauma, and 10 transferred to the ICU via RRT screening. Based on our experience, the role of the ACTs team can help improve patient safety.","PeriodicalId":34662,"journal":{"name":"Journal of Acute Care Surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45313341","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-11-30DOI: 10.17479/jacs.2022.12.3.132
Seung-Young Oh, Jae-myeong Lee, H. Lee, Junsik Kwon, Hak-Jae Lee, N. Choi, Jae Gil Lee, Imgyu Kim, Min Chang Kang, Hyung Won Kim, S. Youn
Purpose: To investigate the status of protein supply by comparing the recommended amount with the delivered amount of protein in patients in the trauma and surgical intensive care units (ICU). Feedback on the protein supply status was presented to each hospital, and we evaluated whether the protein supply had increased to an appropriate level.Methods: In this retrospective observational multicenter study, nutritional information on patients in the trauma and surgical ICUs who had received nutritional support intervention was collected on the 1st Wednesday of each month at two-month intervals from August 2020 to June 2021, from nine domestic hospitals in Korea. Every two months, the nutritional status of each hospital was shared with all hospitals, and each nutritional support team received feedback on protein supply status.Results: There were 246 patients from nine hospitals included in this study, and data over the study period from six protein days, were analyzed. The mean ratios of delivered calories to calculated required calories were 74.0%, 80.8%, 85.4%, 77.9%, 71.3%, and 82.1% on Protein Days 1, 2, 3, 4, 5, and 6, respectively. The mean ratios of delivered protein to calculated required protein were 73.0%, 77.2%, 78.9%, 79.3%, 69.4%, and 89.6% on Protein Days 1, 2, 3, 4, 5, and 6, respectively.Conclusion: Protein supply increased to an appropriate level, feedback on protein supply status may have increased the protein supply ratio and promoted appropriate protein supply and nutritional support for patients in the trauma and surgical ICUs.
{"title":"The Status of Protein Supply to Patients in the Trauma and Surgical Intensive Care Units and the Effects of Feedback on Protein Supply: A Multicenter Study","authors":"Seung-Young Oh, Jae-myeong Lee, H. Lee, Junsik Kwon, Hak-Jae Lee, N. Choi, Jae Gil Lee, Imgyu Kim, Min Chang Kang, Hyung Won Kim, S. Youn","doi":"10.17479/jacs.2022.12.3.132","DOIUrl":"https://doi.org/10.17479/jacs.2022.12.3.132","url":null,"abstract":"Purpose: To investigate the status of protein supply by comparing the recommended amount with the delivered amount of protein in patients in the trauma and surgical intensive care units (ICU). Feedback on the protein supply status was presented to each hospital, and we evaluated whether the protein supply had increased to an appropriate level.Methods: In this retrospective observational multicenter study, nutritional information on patients in the trauma and surgical ICUs who had received nutritional support intervention was collected on the 1st Wednesday of each month at two-month intervals from August 2020 to June 2021, from nine domestic hospitals in Korea. Every two months, the nutritional status of each hospital was shared with all hospitals, and each nutritional support team received feedback on protein supply status.Results: There were 246 patients from nine hospitals included in this study, and data over the study period from six protein days, were analyzed. The mean ratios of delivered calories to calculated required calories were 74.0%, 80.8%, 85.4%, 77.9%, 71.3%, and 82.1% on Protein Days 1, 2, 3, 4, 5, and 6, respectively. The mean ratios of delivered protein to calculated required protein were 73.0%, 77.2%, 78.9%, 79.3%, 69.4%, and 89.6% on Protein Days 1, 2, 3, 4, 5, and 6, respectively.Conclusion: Protein supply increased to an appropriate level, feedback on protein supply status may have increased the protein supply ratio and promoted appropriate protein supply and nutritional support for patients in the trauma and surgical ICUs.","PeriodicalId":34662,"journal":{"name":"Journal of Acute Care Surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48663668","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-11-30DOI: 10.17479/jacs.2022.12.3.97
Koichi Inukai, A. Usui, Y. Hashimoto, Fumitaka Kato, K. Amano, Hiroyuki Kayata, Nobutaka Mukai, Naoki Shinyama
Purpose: Despite widespread adoption of open abdominal management (OAM), there is currently no threshold criterion for OAM duration for non-trauma patients. Moreover, there is a positive relationship between morbidity and the duration of OAM, but an uncertain relationship with patients’ age. Therefore, a novel clinical index for the duration of open abdominal management (IDOM) was developed based on the patient’s age and risk of severe complications following OAM to indicate the maximum tolerable number of days of OAM based on the individual’s age. The utility of this new index was evaluated.Methods: This retrospective study included 65 non-trauma patients managed with an open abdomen (OA) from August 2015 to August 2018. The IDOM was developed based on the patient’s age. The result indicated the maximum number of OA days. Patients’ demographic and operative variables were examined and patient data was assigned to one of two groups according to whether the actual number of OA days was above or below the calculated IDOM. Prevalence of complications between these groups was compared. Measures of validity were employed to assess the utility of the IDOM for patient complications.Results: Sixty-five patients were included. The above-the calculated IDOM group exhibited a significantly longer OA and higher rates of wound complications and postoperative respiratory complications compared with the below the calculated IDOM group. The IDOM predicted the incidence of OA-related complications with a sensitivity of 72.4%, and a specificity of 80.6%.Conclusion: The IDOM is a potentially useful tool for appropriate duration at the outset of OA.
{"title":"Open Abdominal Management Among Non-Trauma Patients: The Appropriate Duration and a New Clinical Index","authors":"Koichi Inukai, A. Usui, Y. Hashimoto, Fumitaka Kato, K. Amano, Hiroyuki Kayata, Nobutaka Mukai, Naoki Shinyama","doi":"10.17479/jacs.2022.12.3.97","DOIUrl":"https://doi.org/10.17479/jacs.2022.12.3.97","url":null,"abstract":"Purpose: Despite widespread adoption of open abdominal management (OAM), there is currently no threshold criterion for OAM duration for non-trauma patients. Moreover, there is a positive relationship between morbidity and the duration of OAM, but an uncertain relationship with patients’ age. Therefore, a novel clinical index for the duration of open abdominal management (IDOM) was developed based on the patient’s age and risk of severe complications following OAM to indicate the maximum tolerable number of days of OAM based on the individual’s age. The utility of this new index was evaluated.Methods: This retrospective study included 65 non-trauma patients managed with an open abdomen (OA) from August 2015 to August 2018. The IDOM was developed based on the patient’s age. The result indicated the maximum number of OA days. Patients’ demographic and operative variables were examined and patient data was assigned to one of two groups according to whether the actual number of OA days was above or below the calculated IDOM. Prevalence of complications between these groups was compared. Measures of validity were employed to assess the utility of the IDOM for patient complications.Results: Sixty-five patients were included. The above-the calculated IDOM group exhibited a significantly longer OA and higher rates of wound complications and postoperative respiratory complications compared with the below the calculated IDOM group. The IDOM predicted the incidence of OA-related complications with a sensitivity of 72.4%, and a specificity of 80.6%.Conclusion: The IDOM is a potentially useful tool for appropriate duration at the outset of OA.","PeriodicalId":34662,"journal":{"name":"Journal of Acute Care Surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44125934","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-11-30DOI: 10.17479/jacs.2022.12.3.125
Min Chang Kang, Kyungwon Lee
Purpose: Patients with coronavirus disease 2019 (COVID-19) should be isolated from others to prevent widespread infection. The purpose of this study was to evaluate the feasibility of performing peripherally inserted central catheter (PICC) placement in patients with COVID-19 isolated in the intensive care unit (ICU) of a small volume center hospital.Methods: This retrospective study included 79 patients who underwent PICC in 2 ICUs. There were 41 patients with COVID-19 who were isolated in an ICU (isolated ICU) and there were 38 patients who required ICU care who did not have COVID-19 (non-isolated ICU). Their medical records including PICC-related complications and clinical variables were compared.Results: PICC placement was performed to maintain long-term intravenous access for 78% of the COVID-19 group and 52.6% of the non-COVID-19 group (p = 0.017). The mean procedure time (minutes) was 15.2 ± 7.58 in the COVID-19 group and 12.6 ± 6.65 in the non-COVID-19 group (p = 0.109). When PICC tip locations were divided into three groups (optimal, suboptimal, and malpositioned), there was no significant difference between the two groups of patients. PICC-related complications in COVID-19 and non-COVID-19 groups included non-functioning catheter (0% vs. 5.3%, p = 0.137), occurrence of swelling or hematoma around PICC inserted site (2.4% vs. 0%, p = 0.333), and PICC-related infection.Conclusion: PICC placement for patients with COVID-19 isolated in the ICU of a small volume center hospital was feasible and safe.
{"title":"Feasibility of Peripherally Inserted Central Catheter Placement in COVID-19 Patients Isolated in the Intensive Care Unit of a Small Volume Center (291-Bed Hospital)","authors":"Min Chang Kang, Kyungwon Lee","doi":"10.17479/jacs.2022.12.3.125","DOIUrl":"https://doi.org/10.17479/jacs.2022.12.3.125","url":null,"abstract":"Purpose: Patients with coronavirus disease 2019 (COVID-19) should be isolated from others to prevent widespread infection. The purpose of this study was to evaluate the feasibility of performing peripherally inserted central catheter (PICC) placement in patients with COVID-19 isolated in the intensive care unit (ICU) of a small volume center hospital.Methods: This retrospective study included 79 patients who underwent PICC in 2 ICUs. There were 41 patients with COVID-19 who were isolated in an ICU (isolated ICU) and there were 38 patients who required ICU care who did not have COVID-19 (non-isolated ICU). Their medical records including PICC-related complications and clinical variables were compared.Results: PICC placement was performed to maintain long-term intravenous access for 78% of the COVID-19 group and 52.6% of the non-COVID-19 group (p = 0.017). The mean procedure time (minutes) was 15.2 ± 7.58 in the COVID-19 group and 12.6 ± 6.65 in the non-COVID-19 group (p = 0.109). When PICC tip locations were divided into three groups (optimal, suboptimal, and malpositioned), there was no significant difference between the two groups of patients. PICC-related complications in COVID-19 and non-COVID-19 groups included non-functioning catheter (0% vs. 5.3%, p = 0.137), occurrence of swelling or hematoma around PICC inserted site (2.4% vs. 0%, p = 0.333), and PICC-related infection.Conclusion: PICC placement for patients with COVID-19 isolated in the ICU of a small volume center hospital was feasible and safe.","PeriodicalId":34662,"journal":{"name":"Journal of Acute Care Surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49149879","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-11-30DOI: 10.17479/jacs.2022.12.3.138
L. Samarakoon, Samip Chandraprakash, R. Fernandes, P. Basnyat
Preperitoneal hernia is a very rare complication following laparoscopic inguinal hernia repair. A 57-yearold male underwent a right inguinal hernia totally extra peritoneal repair on 20/10/2021. Initial recovery was uncomplicated but on post operative day 10, he developed sudden onset of vomiting and abdominal pain. Initial imaging showed small bowel obstruction with a possible transition point. An internal hernia was suspected and he was offered urgent diagnostic laparoscopy following counseling. A preperitoneal defect was noted with distended proximal ileum and collapsed distal ileum and colon. A small bowel runthrough did not reveal any pathological abnormalities. A presumptive diagnosis of a preperitoneal hernia was made, and the defect was closed with a running V lock suture. The patient made an uneventful postoperative recovery. An inadvertent breach in the peritoneum during a totally extra peritoneal repair can lead to preperitoneal herniation of the small bowel and intestinal obstruction postoperatively.
{"title":"A Case of Preperitoneal Herniation of the Small Bowel Causing Intestinal Obstruction Following a Totally Extra Peritoneal Hernia Repair","authors":"L. Samarakoon, Samip Chandraprakash, R. Fernandes, P. Basnyat","doi":"10.17479/jacs.2022.12.3.138","DOIUrl":"https://doi.org/10.17479/jacs.2022.12.3.138","url":null,"abstract":"Preperitoneal hernia is a very rare complication following laparoscopic inguinal hernia repair. A 57-yearold male underwent a right inguinal hernia totally extra peritoneal repair on 20/10/2021. Initial recovery was uncomplicated but on post operative day 10, he developed sudden onset of vomiting and abdominal pain. Initial imaging showed small bowel obstruction with a possible transition point. An internal hernia was suspected and he was offered urgent diagnostic laparoscopy following counseling. A preperitoneal defect was noted with distended proximal ileum and collapsed distal ileum and colon. A small bowel runthrough did not reveal any pathological abnormalities. A presumptive diagnosis of a preperitoneal hernia was made, and the defect was closed with a running V lock suture. The patient made an uneventful postoperative recovery. An inadvertent breach in the peritoneum during a totally extra peritoneal repair can lead to preperitoneal herniation of the small bowel and intestinal obstruction postoperatively.","PeriodicalId":34662,"journal":{"name":"Journal of Acute Care Surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43866791","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-11-30DOI: 10.17479/jacs.2022.12.3.142
G. Kim, Jae Hun Kim, S. Kim
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.
{"title":"Spleen-Preserving Distal Pancreatectomy for Blunt Pancreatic Trauma in a Pediatric Patient","authors":"G. Kim, Jae Hun Kim, S. Kim","doi":"10.17479/jacs.2022.12.3.142","DOIUrl":"https://doi.org/10.17479/jacs.2022.12.3.142","url":null,"abstract":"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.","PeriodicalId":34662,"journal":{"name":"Journal of Acute Care Surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43919347","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-07-31DOI: 10.17479/jacs.2022.12.1.2.86
Gregory Wu, Brianna Bockman, M. Saba, Abiola Mosuro
Superior mesenteric artery syndrome (SMAS) is an uncommon condition which is difficult to diagnose due to non-specificity of symptoms. The most common causes of SMAS are severe weight loss secondary to severe medical conditions, surgical history, and cancer. A 31-year-old male with a history of ulcerative colitis status-post proctocolectomy with ileal pouch-anal anastomosis 10 years prior, presented with progressively worsening weight loss and abdominal pain. Radiographic imaging was consistent with SMAS, which was subsequently confirmed intraoperatively during an emergency surgery in which a Roux-En-Y gastrojejunostomy was performed. Clinicians should be aware that SMAS is a rare but possible complication of ileal pouch-anal anastomosis. Although rare, there should be a low threshold for this diagnosis when obstructive symptoms present.
{"title":"Superior Mesenteric Artery Syndrome: Late Complication of Ileal Pouch-Anal Anastomosis","authors":"Gregory Wu, Brianna Bockman, M. Saba, Abiola Mosuro","doi":"10.17479/jacs.2022.12.1.2.86","DOIUrl":"https://doi.org/10.17479/jacs.2022.12.1.2.86","url":null,"abstract":"Superior mesenteric artery syndrome (SMAS) is an uncommon condition which is difficult to diagnose due to non-specificity of symptoms. The most common causes of SMAS are severe weight loss secondary to severe medical conditions, surgical history, and cancer. A 31-year-old male with a history of ulcerative colitis status-post proctocolectomy with ileal pouch-anal anastomosis 10 years prior, presented with progressively worsening weight loss and abdominal pain. Radiographic imaging was consistent with SMAS, which was subsequently confirmed intraoperatively during an emergency surgery in which a Roux-En-Y gastrojejunostomy was performed. Clinicians should be aware that SMAS is a rare but possible complication of ileal pouch-anal anastomosis. Although rare, there should be a low threshold for this diagnosis when obstructive symptoms present.","PeriodicalId":34662,"journal":{"name":"Journal of Acute Care Surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44907412","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-07-31DOI: 10.17479/jacs.2022.12.2.63
J. Ko, M. Kim, Y. Choi, H. Shim, Hoejeong Chung, J. Jang, K. Bae, Kwangmin Kim
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.
{"title":"Determination of Risk Factors for Predicting Bladder-Urethra Injury in Cases of Pelvic Bone Fracture: A Retrospective Single Center Study","authors":"J. Ko, M. Kim, Y. Choi, H. Shim, Hoejeong Chung, J. Jang, K. Bae, Kwangmin Kim","doi":"10.17479/jacs.2022.12.2.63","DOIUrl":"https://doi.org/10.17479/jacs.2022.12.2.63","url":null,"abstract":"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.","PeriodicalId":34662,"journal":{"name":"Journal of Acute Care Surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49064163","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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