Journal of Acute Care Surgery.2023;13(2):83-83. doi:10.17479/jacs.2023.13.2.83
Journal of Acute Care Surgery
2013 (1, 1) to Present ISSN: 2288-5862
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Journal of Acute Care Surgery.2023;13(2):82-82. doi:10.17479/jacs.2023.13.2.82
Journal of Acute Care Surgery.2023;13(2):81-81. doi:10.17479/jacs.2023.13.2.81
Journal of Acute Care Surgery.2023;13(2):80-80. doi:10.17479/jacs.2023.13.2.80
A Xiphoid Elongation Following a Trauma Laparotomy: A Case Report
Journal of Acute Care Surgery.2023;13(2):78-79. doi:10.17479/jacs.2023.13.2.78
Xiphoid elongation is a rare phenomenon where the xiphoid process elongates after stimuli such as surgery, physical therapy, or trauma. We report on a 47-year-old male involved in a traffic accident who went into cardiac arrest. He received ongoing cardiopulmonary resuscitation for nine minutes before recovery of cardiac rhythm, and transfer from a local hospital to the trauma center. He received management for hypotensive shock which was temporarily corrected using Resuscitative Endovascular Balloon Occlusion of the Aorta, and underwent trauma laparotomy in which ileocolic artery ligation and a splenectomy were performed. Six months later, the patient reported epigastric discomfort when he bent over. A hard, linear mass was palpated along the upper midline incision scar and a computed tomography scan showed an elongated xiphoid process (10 cm). The patient underwent surgical excision, and electrocauterization of the xiphoid process. This is a rare case of xiphoid elongation following multiple stimuli to the xiphoid process.
Let’s Get That Bread Clip: Mechanical or Malignant Large Bowel Obstruction?
Journal of Acute Care Surgery.2023;13(2):74-77. doi:10.17479/jacs.2023.13.2.74
A 60-year-old female presented with symptoms consistent with a large bowel obstruction (LBO). Following confirmation of LBO using imaging, she progressed to a laparotomy which potentially revealed a large rectosigmoid tumor with surrounding adhesions, deemed unresectable. The postoperative course was complicated by an enterocutaneous fistula. She was transferred to a tertiary center and underwent a repeat laparotomy which revealed a large fibrotic mass associated with an intra-luminal bread clip (expiry date 2002). This case report details the interesting causative nature of this LBO and the subsequent surgical management, and complicated postoperative course.
Journal of Acute Care Surgery.2023;13(2):70-73. doi:10.17479/jacs.2023.13.2.70
Fine needle aspiration (FNA) of the thyroid is a well-tolerated minimally invasive procedure. Thyroid abscess, as a complication of FNA in an immune-competent adult, is extremely rare. Diagnosis requires a high index of suspicion, for which treatment is intravenous antibiotics, drainage, and sometimes surgery. Here we present a case of thyroid abscess in an otherwise healthy man who presented with neck pain, rapidly increasing neck swelling, difficulty in swallowing, and hoarseness of the voice that developed two weeks after diagnostic FNA of a thyroid nodule which had been present for ten months. Despite antibiotic treatment, the abscess ruptured into the trachea, requiring surgical intervention. This highlights the importance of maintaining asepsis during FNA of the thyroid. Timely diagnosis of a thyroid abscess is essential to avoid life-threatening airway complications.
Journal of Acute Care Surgery.2023;13(2):66-69. doi:10.17479/jacs.2023.13.2.66
Small intestinal diverticula is a rare occurrence, and their surgical management remains controversial due to the lack of a recognized classification system. Complications such as perforation and obstruction are treated surgically. Their etiology remains nebulous but theories such as damage to the Auerbach’s nerve plexus have been advanced as a possible cause. The concomitant presence of a sigmoid intussusception due to diverticular disease in the same patient is truly a rare occurrence. The vast majority of colonic intussusception is due to malignancy and a benign etiology remains elusive. The reported cases of benign causes include a lipoma and benign lymphadenopathy. We believe this to be the first such case report of a colonic diverticulum causing an intussusception. Despite an exploratory laparotomy of less than sixty minutes, the patient demised in the intensive care unit following an occipital lobe stroke. We believe this case of sigmoid intussusception with concomitant small intestinal diverticula to be the first such case report of its kind in English-language scientific publications.
Journal of Acute Care Surgery.2023;13(2):58-65. doi:10.17479/jacs.2023.13.2.58
Purpose:
General surgeons at regional hospitals should have the primary trauma care skills necessary to treat critically ill trauma patients to withstand transfer. This study was conducted to identify a consensus on primary trauma care skills for general surgeons.
Methods:
An initial list of acute care surgical skills was compiled, and revised by six trauma experts (acute care surgeons); 33 skills were nominated for inclusion in the Delphi consensus survey. Participants (councilors of the Japanese Society for Acute Care Surgery) were presented with the list of 33 trauma care skills and were asked (using web-based software) to rate how strongly they agreed or disagreed (using a 5-point Likert scale) with the necessity of each skill for a general surgeon. The reliability of consensus was predefined as Cronbach’s α ≥ 0.8, and trauma care skills were considered as primarily required when rated 4 (agree) or 5 (strongly agree) by ≥ 80% participants.
Results:
There were 117 trauma care specialists contacted to participate in the Delphi consensus survey panel. In the 1st round, 85 specialists participated (response rate: 72.6%). In the 2nd round, 66 specialists participated (response rate: 77.6%). Consensus was achieved after two rounds, reliability using Cronbach’s α was 0.94, and 34 items were identified as primary trauma care skills needed by general surgeons.
Conclusion
A consensus-based list of trauma care skills required by general surgeons was developed. This list can facilitate the development of a new trauma training course which has been optimized for general surgeons.
Journal of Acute Care Surgery.2023;13(2):47-57. doi:10.17479/jacs.2023.13.2.47
Purpose:
A retrospective descriptive study was performed to develop strategies to manage or prevent pressure ulcers in patients with severe trauma being cared for in the trauma intensive care unit (TICU).
Methods:
Study data was compiled from 315 patients with severe trauma (injury severity score ≥ 15) who were admitted to a general hospital from January 1, 2020, to February 28, 2021 and were being cared for in the TICU. For patients with pressure ulcers, the characteristics and associated factors of pressure ulcers were examined.
Results:
There were 42 severe trauma patients (13.3%) with pressure ulcers, of which, 50.0% of cases occurred at the site of the coccyx. In 50% of patients, Stage 2 pressure ulcers were observed. The mean onset day of pressure ulcers was 9.74 days after admission. The occurrence of diabetes, critical care triage score, length of stay in intensive care, death, shock, dialysis, ventilator application, endotracheal intubation, peripheral insertion central catheter insertion, A-line insertion, body protector application, sedatives, blood pressure boosters, nasal cannula, high-flow oxygenators, oxygen tip application, drainage insertion, nasogastric tube nutrition, and ventilator application period were investigated. Logistic regression analysis revealed that the influencing factors for the development of pressure ulcers were endotracheal intubation, length of stay in the TICU, and age, in that order.
Conclusion
By identifying the characteristics and risk factors associated with pressure ulcers in patients with severe trauma, strategies can be developed to better prevent or manage pressure ulcers in the future.
Country
Republic of Korea
Publisher
Korean Society of Acute Care Surgery
ElectronicLinks
http://www.jacs.or.krEditor-in-chief
Chi-Min Park
journal@jacs.or.kr
Abbreviation
J Acute Care Surg
Vernacular Journal Title
ISSN
2288-5862
EISSN
2288-9582
Year Approved
2017
Current Indexing Status
Currently Indexed
Start Year
2013
Description
Journal of Acute Care Surgery (J Acute Care Surg) is the official journal of the Korean Society of Acute Care Surgery (KSACS) biannually published in Korean or English. It is open access peer-reviewed journal that focuses on acute care surgery. It's pursuing high quality medical research via publishing related papers in the area. J Acute Care Surg encourages submission of manuscripts related to acute care surgery especially surgical critical care, emergency surgery, and trauma.
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