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.

With the widespread adoption of ultrasound-guided (USG) techniques, the traditional landmark-guided infraclavicular approach for central venous cannulation has declined in use. The subclavian vein offers distinct advantages, and there are circumstances where central venous catheter insertion into the subclavian vein (SCV) is necessary, particularly when access to the internal jugular vein is difficult. When the conventional method is challenging, alternative strategies for SCV cannulation are required. This review examines current concepts and available evidence regarding USG supraclavicular brachiocephalic vein (SC-BCV) and infraclavicular axillary vein (IC-AXV) cannulation as practical alternatives for central venous access. USG SC-BCV cannulation has several advantages, including a shorter distance to the target vein, a more direct catheter trajectory to the superior vena cava, and reduced risks of pneumothorax and arterial puncture. Comparative studies and meta-analyses demonstrate higher first-attempt success rates and lower malposition rates compared with landmark-guided IC-SCV cannulation. USG IC-AXV cannulation is also increasingly recognized as a safe and effective option, particularly useful in patients with tracheostomy, chest wall injuries, or infection risks near conventional sites. Evidence suggests that success rates are comparable to those of internal jugular vein (IJV) cannulation, with fewer infectious complications in selected patients. Both SC-BCV and IC-AXV approaches require proficiency with long-axis imaging and precise needle tracking but can be mastered with training. Accumulating evidence supports USG SC-BCV and IC-AXV cannulation as reliable alternatives to both landmark-guided IC-SCV and USG IJV approaches.

This report describes a rare case of bilateral foot burns in a 61-year-old man following a religious firewalking ceremony, an event scarcely documented in the literature. The patient presented with multiple painful foot blisters and ulcers 2 days after the ceremony, accompanied by marked discomfort and impaired mobility. On examination, the right foot showed a large deroofed blister with mild slough, whereas the left foot had an intact, tense bleb. The primary diagnosis was bilateral foot burns complicated by diabetes mellitus. Management included deroofing and dressing the right foot blister, while the left foot blister was aspirated, enabling a direct comparison of two treatment strategies within the same patient. Glycemic control was optimized by adjusting insulin dosages, and wound care was tailored to the clinical condition of each foot. Early multidisciplinary consultation guided infection monitoring and pressure offloading. The outcomes underscored the challenges of burn management in diabetic patients, particularly with regard to delayed wound healing and heightened infection risk. This case highlights the importance of individualized burn blister management and the methodological value of comparing deroofing versus aspiration in a controlled clinical context. The key implication is the need for further research to establish best practices for burn care in high-risk populations, especially following unusual injury mechanisms such as firewalking.

Purpose: This study investigated the influence of disease-related knowledge and health empowerment on health behavior compliance among patients who underwent percutaneous coronary intervention.Methods: This descriptive correlational study involved 155 patients who underwent coronary intervention at a tertiary hospital. Data were collected using structured questionnaires measuring health behavior compliance, disease-related knowledge, and health empowerment from May to August 2024. Data were analyzed with descriptive statistics, the independent t-test, one-way analysis of variance, Pearson correlation coefficients, and multiple regression analysis using SPSS ver. 27.0.Results: Participants showed mean scores of 0.67±0.20 (out of 1) for disease-related knowledge, 3.25±0.99 (out of 5) for health empowerment, and 1.76±0.52 (out of 3) for health behavior compliance. Educational level (t=–5.05, P<0.001) and monthly income (F=11.90, P<0.001) showed significant differences according to health behavior compliance. Multiple regression analysis revealed that health empowerment (β=0.69, P<0.001) and disease-related knowledge (β=0.17, P=0.006) were significant predictors of health behavior compliance, explaining 65% of variance (F=57.50, P<0.001).Conclusion: These findings demonstrate that health empowerment and disease-related knowledge significantly affect health behavior compliance in post–coronary intervention patients. Healthcare providers should implement comprehensive interventions aimed at enhancing these factors to improve patient outcomes.

Purpose: Treatment at a dedicated trauma center significantly reduces the mortality rate after trauma. High-quality trauma care requires well-established systems. Moreover, the presence of an on-site trauma surgeon during resuscitation improves outcomes. Although the trauma system history, including trauma centers in South Korea, is relatively short, it has developed rapidly, and trauma surgeons’ roles have also been established. This study aimed to show clinical performance, particularly in trauma surgery, and the outcomes of a regional trauma center serving as a Level 1 trauma center in South Korea.Methods: Using the Korean Trauma Data Bank, data collected at Ajou University Hospital Trauma Center between January 2020 and December 2022 was retrospectively analyzed. Patients’ demographic characteristics, mechanisms of injuries, trauma surgery types, and outcomes were evaluated.Results: There were 9,205 patients admitted with trauma, of whom 1,149 underwent trauma surgery (including laparotomy, thoracotomy, pelvic packing, neck surgery, and peripheral vascular surgery). A total of 1,787 trauma surgeries were performed, and the mean time to surgery for hypotensive patients with hemorrhagic shock from arrival was approximately 50 minutes. Damage control surgery including laparotomy, thoracotomy, and pelvic packing accounted for 12% of cases. It was determined that the mortality rate (excluding death on arrival) was less than 5%, and the length of hospital stay decreased over the study period.Conclusion: Clinical performance, particularly in trauma surgery, conducted by dedicated trauma surgeons, has led to favorable clinical outcomes at a regional trauma center in South Korea.

Purpose: A trauma team (TT) is reported to improve the management and polytraumas outcome. To assess the impact on, the decision-making process in the execution of surgical and interventional procedures, trauma patient results were examined before and after TT introduction.Methods: This was a non-randomized single-center retrospective study of major trauma patients who accessed our level III university hospital Shock Room (SR) in the 20 months prior to the establishment of the TT (preTT group) and in the following 20 months (postTT group).Results: There were 947 patients (418 preTT, 529 postTT) admitted in the SR due to a traumatic event. Comparing the 2 periods, a significant decreases in time spent in SR (p = 0.008), Sequential Organ Failure Assessment score in the Intensive Care Unit (p = 0.027), and estimated blood loss in Operating Room (p = 0.003) was observed. A significant increase was observed in the number of days of assisted ventilation (p < 0.001), the number of Damage Control Surgery procedures (p = 0.008), and non-operative managements for splenic and liver injuries (p = 0.004).Conclusion: A significant change in the type of surgical procedures performed and increase in the number of non-operative managements were observed in the period following the implementation of the computed tomography; this was particularly evident in splenic trauma management where a complete alignment with the World Society of Emergency Surgery guidelines recommendations was reached. These results demonstrated the management of traumatic pathology with a dedicated TT represents the best approach for polytraumas.

Gallstone ileus is rare complication of cholecystitis or cholelithiasis due to the formation of an aberrant communication between the gallbladder and small bowel. The movement of the gallstone to the small bowel may cause bowel obstruction. A patient presented with acute onset abdominal pain, nausea, vomiting, and tenderness around the umbilical area. Physical exam, laboratory tests, and computed tomography were performed. Within 24 hours the patient had developed peritonitis. He received an emergency exploratory laparotomy, and small bowel resection and anastomosis of the proximal jejunum. The patient had gallstone ileus complicated by the presence of an intraluminal abscess and perforation due to pressure necrosis caused by the gallstone. The patient recovered and was discharged on postoperative day 31. Despite having had a cholecystectomy 20 years prior this case highlights a patient who suffered a rare case of gallstone ileus.

Blunt trauma to the abdomen can result in various injuries which are potentially fatal if not promptly recognized and treated. Mechanism of injury, anatomical location, patient demographics, and clinical profile play crucial roles in diagnosis and management. The article presents 2 cases illustrating the challenges, and successful management of isolated jejunal injuries, and highlight the significance of early recognition and surgical intervention. These injuries are rare and there needs to be a high index of suspicion, especially in cases with atypical presentation. The cases in this article underscore the critical role of early surgical intervention in achieving optimal recovery and reducing the morbidity and mortality associated with isolated jejunal injuries. Clinicians need to consider the possibility of small bowel perforation following apparently trivial injuries, and employ a comprehensive approach to managing abdominal trauma.

Purpose: This study aimed to evaluate the utilization and outcomes of resuscitative endovascular balloon occlusion of the aorta (REBOA) in managing noncompressible torso hemorrhage (NCTH) among trauma patients in Korea. The evolution of REBOA and its impact on patient survival was investigated as well as predictors of mortality.Methods: This retrospective study included 234 post-REBOA patients from 5 leading regional trauma centers across Korea between 2016 and 2021. Primary outcomes were in-hospital mortality, and secondary outcomes were various clinical parameters regarding REBOA, overall treatment flow, and complications. For comparative analyses, patients were dichotomized into in-hospital non-survivors or survivors. Then, generalized additive and linear regression models were used to evaluate the trend of in-hospital mortality.Results: The overall in-hospital mortality was 65.4%. The survivors had a higher proportion of responders following REBOA (87.7% vs 62.7%, <i>p</i> < 0.001). Key variables influencing outcomes included total occlusion time, red blood cell transfusion volume within the first 24 hours, revised trauma score, and systolic blood pressure gap. These factors significantly correlated with mortality rates in multivariate logistic regression.Conclusion: Over 6 years, survival rates for NCTH patients undergoing REBOA in Korea have shown improvement. Despite diverse REBOA protocols across institutions, the results underscore the need for continued research, standardized practices, and national quality control measures to further optimize patient outcome and establish more effective treatment protocols for NCTH.

Purpose: We sought to assess mortality trends in chest-abdominal trauma patients, before and after the implementation of the Project Supporting Establishment of Trauma Centers (PSETC) in the Republic of Korea.Methods: Data from the National Health Insurance Service claims database between 2009 to 2017 were analyzed. Patients with chest-abdominal trauma were defined as those with relevant main diagnosis codes and claims for emergency medical management fees. Mortality and cumulative data were analyzed for each year to compare mortality before and after the establishment of regional trauma centers across Korea (2014).Results: In total, 29,127 patients were included in the analysis. While the annual incidence of trauma-related chest-abdominal injuries increased, mortalities decreased. In particular, the trauma incidence rate among patients over 50 years increased during the study period. Mortalities at trauma centers did not change year by year after the PSETC. Before and after 2014, when trauma centers operated under the PSETC, mortalities decreased [trauma cases before the PSETC; <i>n</i> = 14,321 (mortality 5.61), after the PSETC; <i>n</i> = 14,806 (mortality 4.96)].Conclusion: The number of patients treated for chest-abdominal injuries increased from 2009 to 2017 in Korea, whereas mortalities decreased over the same period.