Case Reports in Emergency Surgery and Trauma
CREST (Case Reports in Emergency Surgery and Trauma) is an international, peer-reviewed journal devoted to expanding the quality of care in the scientific field of Acute Care Surgery & Trauma (ACS&T) by publishing articles reporting clinical cases on this study area. The rationale for publishing case reports in the ACS&T field is double. On the one hand, in this area of study it is extremely costly and difficult to produce studies of the highest degree of scientific evidence (i.e. controlled clinical trials, especially randomised) and on the other hand, clinical cases (and their particular scientific information) find little, if non-zero, dissemination’ chance in the scientific literature. The journal welcomes submissions from international contributors and researchers of all specialties involved in ACS&T. CREST publishes essentially Case Reports or small Case Series (and eventually Letter) related to the practice in the field of ACS&T. Clinical cases published on CREST must comply, in addition to originality, with three other conditions: to follow the CARE guidelines for publication of case reports (https://www.care-statement.org/); to report a comprehensive review of the central topic of the case report in the Discussion section; to indicate in the conclusions the fundamental "learning" obtained from the clinical case. CREST is supported by SIFIPAC (Società Italiana di Fisiopatologia Chirurgica, Italian Society of Surgical Physiopathology).
Enhancing surgical decision-making: the critical need for structured ultrasound training in residency. A case report of acute necrotic cholecystitis
Acute necrotic cholecystitis (ANC), marked by gallbladder wall necrosis, carries high morbidity if diagnosis and treatment are delayed. Ultrasound is the first-line imaging for suspected cholecystitis, but its sensitivity for necrosis is limited. This case underscores the value of surgical ultrasound competency in emergency decision-making. A 57-year-old woman with diabetes, asthma, and hypothyroidism presented with severe epigastric pain and systemic inflammation. Emergency ultrasound showed gallbladder wall thickening, pericholecystic fluid, and gallstones. CT confirmed necrosis with possible microperforation. An informal ultrasound by surgical residents later that day identified microperforations, expediting the decision for subtotal laparoscopic cholecystectomy. Surgery was successful, and recovery was uneventful. Ultrasound, when performed by trained surgical teams, enables rapid diagnosis and management of complex cholecystitis. Structured ultrasound training during residency could enhance diagnostic accuracy, reduce treatment delays, and improve outcomes in acute surgical emergencies.
Copyright (c) 2025 the Author(s) http://creativecommons.org/licenses/by-nc/4.0
A rare case of acute abdomen caused by diverticulum perforation in the jejunum
Diverticulitis of the small bowel is a rare condition that is typically asymptomatic. This study presents a case of diverticulitis of the jejunum in a 70-year-old male. The patient presented to our clinic with acute abdominal pain. Abdominal CT revealed the presence of a diverticulum in the jejunum with mesenteric air and fat stranding. Due to clinical deterioration, the patient was taken to the operating room for surgical exploration. Exploratory laparoscopy revealed multiple diverticula in the proximal jejunum over a length of 50 cm, with signs of diverticulitis in one segment. The laparoscopic procedure was converted to an open approach. A segmental resection of the small bowel was performed, which included the inflamed portion and most of the diverticulum. Laparoscopy and laparotomy are both recommended for managing complications associated with diverticulitis in the jejunum. In cases with complications such as perforation and abscess formation, segmental resection is the preferred approach.
Colon perforation from an uncommon cause: a case report
Pelvic fractures are frequently associated with concomitant injuries to intra-abdominal and genitourinary structures. We report an unusual case of colonic perforation secondary to entrapment of the sigmoid colon within a complex pelvic fracture. A 59-year-old male sustained a high-energy blunt trauma following a motor vehicle rollover. Upon presentation to the Emergency Department, he was responding with an intact airway and hemodynamically normal and stable. Auscultation revealed normal and symmetrical breath sounds bilaterally (SpO2 98%). The patient was alert, oriented, and scored 15/15 on the Glasgow Coma Scale. Physical examination revealed pelvic instability. Whole-body computed tomography (CT) demonstrated an anteroposterior compression (APC) Type III pelvic ring injury with herniation and perforation of the sigmoid colon into the fracture site, accompanied by free air. The patient underwent emergency exploratory laparotomy, which confirmed the diagnosis. A sigmoidectomy with Hartmann’s procedure was performed. Definitive pelvic stabilization was achieved in a subsequent operative session. Incarceration of bowel loops within pelvic fractures is exceedingly rare but represents a surgical emergency due to the risk of fulminant sepsis and mortality. Early radiologic identification and prompt surgical management are imperative. A high index of suspicion is warranted in patients with complex pelvic fractures, particularly in the presence of free intraperitoneal air or signs of peritonitis.
Lower gastrointestinal bleeding as a rare manifestation of small bowel and colon tuberculosis: a case report
Tuberculous enteritis (TE) is an exceptionally rare cause of lower gastrointestinal (GI) bleeding, especially in elderly patients. Its clinical presentation can mimic more common conditions such as diverticular disease, malignancy, or inflammatory bowel disease, making early diagnosis challenging. This case concerns an 89-year-old female patient who was transferred from the Internal Medicine Department to our clinic due to persistent lower GI bleeding. The patient underwent two gastroscopies, which revealed no significant findings, and two colonoscopies. The first colonoscopy showed diverticula in the descending colon, while the second identified a 1 cm ulcer with a whitish coating in the transverse colon. A computed tomography (CT) scan revealed pulmonary consolidation, atelectasis, and intraperitoneal fluid, along with sigmoid diverticula. Due to ongoing hemodynamic instability, the patient underwent urgent subtotal colectomy and terminal ileostomy. Intraoperative findings included blood clots filling the ileum and colon, wall thickening, multiple diverticula, and ascitic fluid. Histopathological analysis confirmed tuberculosis (TB) with the presence of epithelioid granulomas.
Late-onset bleeding due to displaced lesser trochanter after a short gamma nail: a case report
An 89-year-old female patient presented to the emergency department with a spontaneously occurring and rapidly increasing swelling and pressure pain in her left thigh. Five weeks previously, she had suffered a pertrochanteric femur fracture on the left side following a domestic fall, which was surgically treated with a short gamma nail. Following an uneventful post-operative course, the patient was discharged to a rehabilitation clinic. A CT angiography confirmed the clinical suspicion of bleeding, identifying the profunda femoris artery as the source. The cause of the vascular injury was the displaced lesser trochanter. By implanting a covered stent, the active bleeding was stopped, and after stabilizing the patient, the hematoma was surgically removed, whereby the lesser trochanter was left alone.
Left thoracoscopic repair of iatrogenic esophageal rupture: a case report of an achalasia patient
Iatrogenic esophageal ruptures occur rarely, but they can be life threatening and have severe complications. They can lead to the development of sepsis and have high rates of morbidity and mortality. The most common cause of iatrogenic esophageal perforation is curative treatment endoscopy. This case report focuses on the case of a 62-year-old female patient presenting with acute chest pain after pneumatic dilation for achalasia, which was found to be a thoracic esophageal rupture.
Perilunate trans-triquetral fracture dislocation: a case report
We present an unusual case of trans-styloid trans-triquetrum perilunate fracture dislocation, in which the radial-sided carpal bones remained intact but the lunotriquetral (LT) and scapholunate (SL) ligaments were torn. A 28-year-old male presented to our emergency department after sustaining a fall from a height of 2 m on an outstretched hand with hyperextension of the wrist, landing on the ulnar aspect of the palm of his hand. Imaging investigation revealed a dorsal perilunate trans-styloid trans-triquetrum fracture dislocation. We performed open reduction and internal fixation of the radial styloid and triquetral fractures, and repair of the LT and SL ligaments. This report describes a rare trans-triquetral dorsal perilunate fracture dislocation with a concomitant LT ligament rupture. It deviates from Mayfield and Johnson’s theory by showing the potential for a reverse greater arc injury, advancing from the ulnar to the radial side, sometimes leaving radial carpal bones unaffected.
We present the case of a 72-year-old male admitted with a giant infected hydrocele. His medical history includes a transurethral resection of the prostate for benign prostatic hyperplasia and a total thyroidectomy complicated by postoperative hematoma necessitating a tracheostomy. The patient reported a three-year history of right hemiscrotal enlargement, with significant symptom exacerbation in the preceding month. Physical examination revealed a markedly enlarged, tender scrotum with epidermolysis and a body temperature of 38°C. Laboratory findings showed leukocytosis and elevated C-reactive protein levels. Imaging studies demonstrated well-vascularized testes with significant inflammatory changes and septations, consistent with a complex hydrocele. Surgical intervention involved drainage of approximately 3 liters of purulent fluid, debridement of necrotic tissue, and right orchiectomy. Postoperative management included a 10-day course of antibiotics, leading to favorable progress. The patient was discharged on the tenth postoperative day and remained in good health at the three-month follow-up.
Gallbladder perforation following abdominal liposuction: case report of a radiological pitfall
Liposuction is a widely performed aesthetic procedure. However, its potential for serious complications remains underestimated. We report a rare case of delayed liver trauma and gallbladder perforation in a 33-year-old woman following abdominal liposuction. After developing persistent abdominal pain, imaging revealed perihepatic fluid collections but failed to clearly identify a gallbladder injury. The clinical examinations suggested the presence of a localized peritonitis; therefore, an exploratory laparoscopy was performed, showing a minor hepatic injury and an active bile leakage from a gallbladder perforation, necessitating a laparotomic cholecystectomy. The patient recovered uneventfully. This case report underscores the importance of clinical judgment when imaging is inconclusive and highlights the role of diagnostic laparoscopy in the management of intra-abdominal injuries.
Delayed complicated extraperitoneal bladder rupture after blunt trauma: a case report
We present a case of extraperitoneal bladder rupture occurring 15 days after pelvic trauma, despite no apparent bladder injury being evident at the time of the incident. A 66-year-old male fell from a height of 20 feet and sustained injuries to the chest, pelvis, and left upper and lower limbs. All injuries were managed uneventfully. On the day of his planned discharge, he developed acute abdominal distension with suprapubic tenderness and gross hematuria. Imaging revealed a complicated extraperitoneal bladder rupture, which warranted surgical repair in this case due to its complicated nature. He was discharged on a follow-up basis with a suprapubic catheter in situ.
Beyond breathless: a case of air infiltrating every cavity
Hawaii attracts 10 million tourists annually, with non-residents accounting for 9% of trauma cases, half of which are water-related. We experienced a SCUBA tank injury, causing extensive trauma from pressurized air release. A 53-year-old female, post-Scuba diving, fell onto a SCUBA tank, causing rapid pressurized air discharge. She presented with perineal pain, bloating, and extensive subcutaneous emphysema. CT revealed air in every possible cavity. Thoracostomies and exploratory laparotomy performed, revealing an 80-90% anal sphincter transection. An overlapping anal sphincteroplasty with diverting loop ileostomy was performed. Recovery was uncomplicated. This unique case involves a traumatic SCUBA tank air release causing extensive damage. The patient avoided direct anorectal entry, preventing catastrophic damage but sustained an anal sphincter complex injury. Air likely entered the peritoneum through the levator ani, causing pneumoperitoneum and pneumothoracies. The extensive damage emphasizes the need for safe water sports practices. The patient’s recovery highlights the human body’s resilience in unique situations.
Copyright (c) 2024 the Author(s) http://creativecommons.org/licenses/by-nc/4.0
Catastrophic uterine rupture of an unscarred uterus following motor vehicle rollover – a case report
A 22-year old female at 6 months gestation with no history of prior abdominal surgery or previous uterine procedures presented via air transport after highway motor vehicle rollover. Due to hemodynamic instability, the only preoperative imaging that was able to be obtained was bedside sonography, which confirmed free fluid in the upper quadrants and unfortunately, fetal demise. In the operating room, source of bleeding was noted to be multiple large uterine ruptures. Uterine rupture in trauma in the absence of prior uterine surgery is a rare event and has never been reported in the third trimester, however it should remain in the differential for a pregnant trauma patient presenting with hemodynamic instability.
Traumatic carotid artery dissection in polytrauma: is conservative treatment an adequate strategy? A case report
We present the case of a 24-year-old man, involved in a car accident, with a traumatic right carotid artery dissection Grade II Blunt CerebroVascular Injury (BCVI) according to the Eastern Association for the Surgery of Trauma (EAST). The patient arrived at our hospital without neurological symptoms and was then admitted to the Intensive Care Unit (ICU) for neurological monitoring; antithrombotic and antiplatelet therapy was initiated and in line with current literature, no routine endovascular treatment was performed. Twenty-four hours post-trauma, the patient required an urgent abdominal surgical intervention under general anesthesia. Upon awakening, he presented with left hemiplegia. The CT scan revealed hypodensity in the front-insular region prompting an urgent endovascular procedure. Fourteen days post trauma the patient was discharged from the Stroke Unit with an unchanged neurological performance, despite receiving appropriate treatment for Grade II BCVI, as recommended in current literature. Our patient developed a severe neurological disability. Further discussions are needed.
Sneeze-induced transvaginal small bowel evisceration and obstruction nine months after iatrogenic vaginal vault laceration: a case report
Transvaginal evisceration (TE) is the extrusion of intra-abdominal viscera through the vagina. According to the literature, few cases have been reported, most of them involving elderly women who underwent previous pelvic surgery. Here we present the case of a 72-year-old woman who was admitted to our hospital due to the sensation of vaginal obstruction that appeared after a sneeze nine months after a repair of a vault laceration following prior complex pelvic surgery. A clinical diagnosis of small bowel transvaginal evisceration with obstruction was quickly made. In this case, adhesions, bowel obstruction, and the presence of a fibrotic scar on the vaginal vault were the main obstacles to the repair. However, a multidisciplinary evaluation and a combined laparoscopic-transvaginal minimally-invasive approach proved to be safe and effective in achieving good surgical outcomes in the treatment of this condition.
Post-traumatic biliopleural fistula treated with endoscopic retrograde cholangiopancreatography: a case report
Thoracobiliary fistulae are a rare disorder caused by iatrogenic injury or trauma. Because these fistulae are uncommon, no standard of care has been established, but non-operative management (NOM) is often advised. As a result, endoscopic retrograde cholangiopancreatography (ERCP) appears to be playing a growing role in the treatment of select cases. A 42-year-old male patient involved in a street fight developed a biliopleural fistula as a result of an abdominal penetrating injury. Even in the lack of a clearly defined site of biliary leak, NOM and ERCP have proven to be safe and effective therapy in this case.
Copyright (c) 2023 the Author(s) http://creativecommons.org/licenses/by-nc/4.0
Why publish on Case Report in Emergency Surgery and Trauma (CREST)?
In medicine and surgery, a case report (CR) is a comprehensive or intensive analysis of a single individual or particular group, while a case series is an association of similar CRs. A CR includes an exhaustive narrative report of the symptoms, signs, diagnosis, treatment and follow-up of a patient. CRs usually describe an unusual or novel occurrence or disease and sometimes contain a literature review of other reported cases. CRs can also be professional accounts that provide feedback on clinical practice guidelines and offer a framework for early signals of effectiveness, adverse events, and costs. They can be shared for medical, scientific, or educational purposes. CRs are always peer-reviewed, like other scientific journal article types. [...]
Adult sigmoid intussusception as a rare presentation of advanced adenocarcinoma: a case report
Adult bowel intussusception is a rare clinical entity resulting in 1-5% of intestinal obstructions. It occurs more often in the small intestine and it’s secondary to a pathologic condition in 90% of cases. Its clinical picture can be unspecific, and the diagnosis is often made intraoperatively. We describe an uncommon clinical presentation of this rare clinical entity. A 69-year-old female presented in our emergency room with severe abdominal pain and rectorrhagia. The abdomen computed tomography scan revealed a colonic intussusception and a mass suggestive of a malignancy, as confirmed by rectosigmoidoscopy. The patient underwent the Hartmann procedure. A histopathological examination revealed an advanced colorectal adenocarcinoma as the lead point of the intussusception. Adult sigmoid intussusception is a rare cause of bowel obstruction, and it is often cancer-related. Symptoms can be nonspecific, and diagnosis is best made by CT imaging and endoscopic investigations which allow for planning surgery.
The Rigler’s triad: a case of gallstone ileus
Rigler’s triad is an extremely rare syndrome that accounts for 4% of all cases of small intestinal obstruction (SBO). This illness is distinguished by three clinical and radiological features: pneumobilia, a severe intestinal blockage, and an abnormally placed gallstone in the gallbladder. An 84-year-old woman arrives at the Emergency Department with symptoms of SBO. The CT scan is essential for detecting the trio. An emergency laparoscopy with an enterotomy and gallstone extraction was conducted successfully. The Rigler’s triad should be suspected in elderly individuals with a history of gallstones in the gallbladder, especially in the emergency scenario. Large and solitary gallstones in the gallbladder that are asymptomatic should be candidates for cholecystectomy. In conclusion, this case is a very didactic instance, particularly because of the crisp CT images that can assist surgeons in identifying gallstone ileus and the mini-invasive method that can also benefit in an emergency context.
An unexpected intrabdominal discovery: a mesenteric desmoid tumor with small bowel obstruction. Case report and literature review
This case report describes a 54-year-old man who presented with abdominal discomfort, nausea, early satiety, and constipation. A CT scan revealed a large mass infiltrating the mesentery and close to bowel loops, raising suspicion of intestinal sub-occlusion. Urgent surgery was performed, resulting in a segmental jejunum resection to remove the identified mesenteric mass. Histological examination revealed a diagnosis of desmoid fibromatosis which is a rare type of soft tissue tumor with borderline malignancy that can cause bowel obstruction when it develops intra-abdominally. It is often associated with genetic predispositions and risk factors such as previous surgery and pregnancy. The case highlights the importance of considering a patient's surgical history when encountering desmoid fibromatosis to determine the most appropriate treatment approach.
Boerhaave’ syndrome in a case of acute exacerbation of chronic obstructive pulmonary disease managed with non-invasive ventilation: a case report
Barotraumatic esophageal rupture (Boerhaave’ syndrome) is a rare and life-threatening disease, described as a Non-Invasive Ventilation (NIV) complication in a very small series. We report the case of a 72-year-old man admitted to the Emergency Department for severe dyspnea in a Chronic Obstructive Pulmonary Disease stage Gold III. After NIV treatment, the patient suffered esophageal perforation with mediastinal and pleural contamination: emergency surgical treatment was successful for the esophageal repair, but the patient developed a fatal septic shock 12 days after surgery. Among NIV complications, few cases concern esophagogastric perforation: our case report describes an uncommon clinical situation treated with a successful damage control surgery approach.
Tardive transvaginal small bowel evisceration after colpohysterectomy: a case report of a rare surgical emergency
Transvaginal small bowel evisceration is a rare surgical emergency after gynaecological surgery with around 100 cases described in literature from 1864. Its diagnosis is merely clinical. The surgical treatment is time-depending because of the risk of acute small bowel ischemia. A 71-year-old female presented in our emergency room complaining abdominal pain, vomiting, and small bowel evisceration through the vagina. She suffered gynaecological prolapse and underwent transvaginal hysterectomy four years earlier. At the clinical examination, intestinal loops were oedematous, dusky, vascular sufferance, and without peristalsis. An urgent laparotomy was performed to reduce the prolapsed bowel, resect the ischemic loop, and vaginal cuff closure. Transvaginal bowel evisceration is a delay complication after hysterectomy. It is a life-threatening condition that requires prompt recognition and surgical management.
Is T3 appendiceal goblet cell adenocarcinoma still an oncological riddle for acute care surgeons? A case report
Appendectomy for acute appendicitis is one of the most commonly performed surgical procedures nowadays. Here we present the case of a 48-year-old man who was admitted to our emergency department with abdominal pain suggestive of acute appendicitis. Then, the patient underwent a laparoscopic appendectomy, and the histological examination of the surgical specimen revealed an unexpected occult neoplasm: goblet cell adenocarcinoma (GCA). After a multidisciplinary evaluation, a right colectomy was performed with good oncological and clinical outcomes at the 1-year follow-up evaluation. To date, either nonoperative strategies or surgical radicalization treatment have been proposed for this condition. Therefore, the choice of the proper therapeutic algorithm is still a challenge for surgeons. This case report is an addition to the existing literature to hold surgeons' attention when managing such cases: multidisciplinary evaluation and patient-targeted therapies are the key steps to achieving good oncological and surgical outcomes.