International Journal of Emergency Medicine最新文献

{"title":"The art and science of head nerve blocks in urgent care settings.","authors":"Zoë M Rushetsky, Grace E Lynch, Bhavik Singh, Ambika Jokhulall, Donald Penney","doi":"10.1186/s12245-026-01362-3","DOIUrl":"10.1186/s12245-026-01362-3","url":null,"abstract":"<p><p>The purpose of this review is to describe the role of regional scalp nerve blocks as an alternative to direct local infiltration for head and scalp laceration repair in emergency and urgent care settings, where tissue swelling from infiltration can obscure landmarks and complicate wound closure. Methods included a narrative review of published studies and procedural descriptions focusing on scalp sensory anatomy, nerve block techniques, anesthetic selection, and safety considerations, along with the development of simplified illustrations and surface-landmark images tailored to outpatient clinicians. Results demonstrate that regional scalp blocks reliably provide effective anesthesia with less tissue distortion and lower anesthetic volume than infiltration, yet existing resources are often highly technical or dispersed across subspecialty literature. The diagrams created for this review consolidate essential anatomic and procedural information into a format that is easier to reference during clinical care and illustrate how a small number of targeted injections can anesthetize common laceration patterns involving the forehead, temporal region, and occiput. The conclusion is that regional scalp nerve blocks are safe, efficient, and less frequently incorporated into routine emergency practice for selected head and scalp injuries, and that combining current evidence with practical visual guides may increase clinician confidence and adoption in urgent care environments.</p>","PeriodicalId":13967,"journal":{"name":"International Journal of Emergency Medicine","volume":"19 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13560293/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148929936","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction: Impact of early cardiac arrest recognition by emergency medical service dispatchers on out-of-hospital cardiac arrest: a retrospective population-based observational study.","authors":"Koji Yamamoto, Hirozumi Okuda, Arisa Kinoshita, Toru Osaki, Keisuke Tsuruta, Keita Miyazaki, Hideki Asai, Yasuyuki Kawai, Hidetada Fukushima","doi":"10.1186/s12245-026-01353-4","DOIUrl":"10.1186/s12245-026-01353-4","url":null,"abstract":"","PeriodicalId":13967,"journal":{"name":"International Journal of Emergency Medicine","volume":"19 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13555962/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148911905","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Temporal trends and patterns of pre-hospital emergency medical service utilization in Yasuj, Southwest Iran: a four-year registry-based cross-sectional study.","authors":"Faezeh Alipour, Seyed Mohammad Ali Afzali, Salar Dasdar","doi":"10.1186/s12245-026-01361-4","DOIUrl":"10.1186/s12245-026-01361-4","url":null,"abstract":"<p><strong>Background: </strong>Pre-hospital Emergency Medical Services (EMS) are essential for the timely management of traumatic injuries and acute medical emergencies. This study evaluated temporal trends, epidemiological characteristics, and utilization patterns of pre-hospital EMS missions in Yasuj, Southwest Iran, from 2020 to 2023.</p><p><strong>Methods: </strong>This registry-based cross-sectional study included all eligible EMS missions recorded in the Asayar pre-hospital EMS registry between January 2020 and December 2023. Data on patient age, mission date, season, hour of occurrence, chief complaint, mission outcome, and ambulance operational code were analyzed. Mission characteristics were summarized using descriptive statistics, and effect sizes were considered alongside statistical significance for categorical analyses. Temporal trends were evaluated using 48 monthly observations in a time-series regression model of log-transformed monthly mission counts, accounting for calendar-month seasonality and first-order autoregressive [AR(1)] errors.</p><p><strong>Results: </strong>A total of 159,073 EMS missions were analyzed. Annual mission volume increased from 28,312 in 2020 to 58,287 in 2023, corresponding to an approximate compound annual growth rate of 27.2%. Monthly mission volume increased by an estimated 1.82% (multiplicative monthly change = 1.018; 95% CI: 1.010-1.026; p < 0.001), with no significant residual autocorrelation (Ljung-Box p = 0.623). Road traffic accidents were the leading cause of EMS activation (24.9%). Adults aged 30-39 years represented the largest age group among missions with recorded age (20.31%). EMS utilization was highest in summer and during evening hours, while cardiovascular-related complaints and carbon monoxide poisoning were more frequent in winter. Effect sizes for categorical associations were generally small.</p><p><strong>Conclusions: </strong>EMS utilization in Yasuj increased substantially over the study period and showed distinct temporal, seasonal, and epidemiological patterns. These findings can support data-driven EMS planning, resource allocation, seasonal preparedness, and policy development. Future studies incorporating comprehensive operational and geographic data are warranted.</p><p><strong>Clinical trial number: </strong>Not applicable.</p>","PeriodicalId":13967,"journal":{"name":"International Journal of Emergency Medicine","volume":"19 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13548603/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148905626","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial intelligence in emergency medicine: from algorithmic performance to real-world clinical integration - understanding the implementation gap.","authors":"Ritu Khandelwal, Charuta Gadkari, Aditya Pundkar, Darshil Khared, Aditya Shrivastav","doi":"10.1186/s12245-026-01333-8","DOIUrl":"10.1186/s12245-026-01333-8","url":null,"abstract":"<p><strong>Background: </strong>Emergency departments (EDs) operate under time pressure, diagnostic uncertainty, and cognitive overload. Artificial intelligence (AI)-driven clinical decision support systems (CDSS) promise to enhance diagnostic accuracy, risk stratification, and workflow efficiency. However, translation from algorithmic performance to bedside integration remains inconsistent.</p><p><strong>Main body: </strong>This narrative review synthesizes current evidence on AI-based CDSS in emergency medicine, focusing on diagnostic performance, clinical impact, and implementation barriers. Literature published between 2015 to December 2025 was reviewed across PubMed, Scopus, and Embase. Applications include AI-assisted triage, sepsis prediction, stroke identification, ECG interpretation, imaging analysis, and ED operational forecasting. Many systems demonstrate strong retrospective performance (AUROC 0.85-0.95) and earlier identification of high-risk patients compared with conventional scoring tools. However, prospective multicenter validation demonstrating mortality reduction or sustained length-of-stay improvement remains limited. Performance degradation across institutions, algorithmic bias, data governance challenges, workflow disruption, alert fatigue, medico-legal ambiguity, and lack of explainability are persistent barriers to adoption. Evidence suggests AI is most effective when deployed as decision augmentation rather than autonomous replacement.</p><p><strong>Conclusions: </strong>AI-CDSS in emergency medicine demonstrates promising diagnostic capability but limited real-world outcome validation. Future development must prioritize prospective implementation trials, transparent model reporting, clinician engagement, and equitable performance across diverse populations to ensure safe and effective integration into emergency care systems.</p>","PeriodicalId":13967,"journal":{"name":"International Journal of Emergency Medicine","volume":"19 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13531917/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148873861","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction: War-related penetrating cervicothoracic trauma managed in a resource-limited hospital in Syria: a case series.","authors":"Issam Alkhayer, Mohammad Alaa Aldakak, Youssef Abbas","doi":"10.1186/s12245-026-01352-5","DOIUrl":"10.1186/s12245-026-01352-5","url":null,"abstract":"","PeriodicalId":13967,"journal":{"name":"International Journal of Emergency Medicine","volume":"19 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13520343/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148840097","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic accuracy of transthoracic ultrasound for detection of pneumothorax, hemothorax, and lung contusion in trauma patients: comparison with chest radiography.","authors":"Mohamed Fawzy Tantawy, Hady Saleh Abou-Ashour, Mahmoud Mousa Elhabashy, Ali Hamouda Ali, Rehab Mohammed Habib","doi":"10.1186/s12245-026-01319-6","DOIUrl":"10.1186/s12245-026-01319-6","url":null,"abstract":"<p><strong>Background: </strong>Thoracic trauma is a major cause of morbidity and mortality in trauma patients. Rapid detection of pneumothorax, hemothorax, and lung contusion is critical for timely management. This study aimed to evaluate the diagnostic accuracy of transthoracic ultrasound compared with chest radiography in thoracic trauma patients using chest computed tomography (CT) as the reference standard.</p><p><strong>Methods: </strong>This prospective diagnostic accuracy study was conducted in the Emergency Department of Menoufia University Hospital between July 2023 and December 2024. Adult trauma patients with suspected thoracic injury were consecutively enrolled. All patients underwent transthoracic ultrasound, chest radiography, and chest CT. Diagnostic performance of ultrasound and chest radiography for detecting pneumothorax, hemothorax, and lung contusion was assessed using CT as the reference standard. Sensitivity, specificity, predictive values, accuracy, and Cohen's kappa agreement were calculated.</p><p><strong>Results: </strong>A total of 76 trauma patients were included in the final analysis (mean age 42.5 ± 12.7 years; 77.6% male), with blunt trauma accounting for 78.9% of injuries. CT identified pneumothorax in 45 patients (59.2%), hemothorax in 53 (69.7%), and lung contusion in 57 (75.0%). Transthoracic ultrasound detected pneumothorax in 41 patients (53.9%), hemothorax in 51 (67.1%), and lung contusion in 49 (64.5%), whereas chest radiography detected these injuries in 31 (40.8%), 33 (43.4%), and 14 patients (18.4%), respectively. Ultrasound demonstrated higher diagnostic performance than chest radiography across all injury types. For pneumothorax detection, ultrasound showed 91% sensitivity and 95% diagnostic accuracy compared with 69% sensitivity and 82% accuracy for chest radiography. For hemothorax detection, ultrasound achieved 96% sensitivity and 97% accuracy versus 62% sensitivity and 74% accuracy for chest radiography. For lung contusion detection, ultrasound demonstrated 86% sensitivity and 89% accuracy, whereas chest radiography showed only 25% sensitivity and 43% accuracy. Agreement with CT was strong for ultrasound (κ = 0.75-0.94) but lower for chest radiography (κ = 0.14-0.64).</p><p><strong>Conclusion: </strong>Transthoracic ultrasound demonstrated high diagnostic performance and good agreement with chest CT for detecting traumatic thoracic injuries and outperformed chest radiography in this study. However, given the single-center design and relatively limited sample size, larger multicenter studies are warranted to validate these findings.</p>","PeriodicalId":13967,"journal":{"name":"International Journal of Emergency Medicine","volume":"19 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13504962/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148818323","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cognitive strategies in the Emergency Medical Services: proposal for a conceptual integrated framework to explicate clinical reasoning in EMS.","authors":"Bert Dercksen, Wolter Paans, Michel M R F Struys, Fokie Cnossen","doi":"10.1186/s12245-026-01355-2","DOIUrl":"10.1186/s12245-026-01355-2","url":null,"abstract":"<p><strong>Background: </strong>Clinical reasoning is fundamental to safe and effective Emergency Medical Services (EMS) care. EMS providers operate in dynamic, time-pressured environments characterised by diagnostic uncertainty, limited information, and high-stakes decisions. These conditions necessitate rapid yet adaptable reasoning strategies.The SPART model was developed through focused ethnography and content validation to describe observable diagnostic and therapeutic activities in EMS practice. It provides a structured representation of the care process from dispatch to transfer of care, serving as a basis for the clinical reasoning (CR) process executed by EMS providers. While it clarifies what EMS providers do, it does not explicate the cognitive processes underpinning these activities.The Dual-Process Theory (DPT) has been widely adopted to explain clinical reasoning, distinguishing between intuitive (System 1) and analytic (System 2) processes. In addition to the two systems defined in the DPT, a third, supervisory metacognitive (System 3), was proposed. To our knowledge, the DPT and the System 3 concept have not yet been explicitly integrated with EMS-specific workflow models. As a result, cognitive explanations and process descriptions of CR in EMS remain conceptually disconnected.</p><p><strong>Aim: </strong>To present a theory-based integrated framework that explicates clinical reasoning in EMS by integrating the SPART model, Dual-Process Theory, with a supervisory metacognitive system.</p><p><strong>Method: </strong>A conceptual synthesis grounded in cognitive psychology and the diagnostic reasoning literature, explicitly mapped onto the empirically derived SPART workflow, was conducted.</p><p><strong>Results: </strong>The conceptual integrated framework views EMS clinical reasoning as an ongoing interaction between intuitive and analytical processes, overseen by a metacognitive supervisory system, and situated within the SPART phases of EMS care. The model explains adaptive decision-making, bias mitigation, and complex disposition decisions such as non-conveyance.</p><p><strong>Conclusion: </strong>This paper addresses the gap between the theory and practice of EMS clinical reasoning by introducing a cognitive framework explicitly aligned with SPART, integrating Dual-Process Theory (DPT) and a supervisory metacognitive system, thereby enabling a combined understanding of workflow and cognition in EMS practice.</p>","PeriodicalId":13967,"journal":{"name":"International Journal of Emergency Medicine","volume":"19 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13508442/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148818351","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Road traffic injuries in Kandy District, Sri Lanka: a prospective analysis of trauma and disability at a tertiary care center.","authors":"Owen Ramberg, Peter Acker, Bo Gu, Isabel Yingjie Weng, Angelica Pritchard, Marisa Smith, Timothy Batchelor, Patrick Lanter, Navodya Selvaratnam, Samath Dharmaratne","doi":"10.1186/s12245-026-01349-0","DOIUrl":"10.1186/s12245-026-01349-0","url":null,"abstract":"<p><strong>Background: </strong>Road traffic injuries (RTIs) are a leading cause of mortality and disability globally, with the greatest burden borne by low- and middle-income countries (LMICs). Sri Lanka continues to experience substantial RTI burden, yet prospective data describing injury characteristics and short-term functional outcomes outside the capital remain limited. We aimed to describe patterns of injury and trauma severity, modes of transport and access to care, and short-term functional outcomes at discharge and during early follow-up among patients presenting with road traffic injuries to a tertiary hospital in Sri Lanka's Central Province.</p><p><strong>Methods: </strong>We conducted a prospective observational study at National Hospital Kandy from March-September 2024. Consecutive patients presenting with road traffic-related injuries were prospectively enrolled.Trained research assistants collected sociodemographic, crash and transport characteristics, and clinical data using standardized structured interviews and bedside chart review in REDCap (English/Sinhalese/Tamil). Trauma severity was assessed using the Kampala Trauma Score (KTS). Functional disability was measured at discharge and at 3 and 6 weeks post-injury using the 12-item World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0). Analyses were descriptive.</p><p><strong>Results: </strong>A total of 567 patients were enrolled (mean age 37.8 years; 77.1% male). Motorcycle drivers (37.1%) and pedestrians (16.2%) were the most common road users. Injuries most frequently involved the lower extremities (56.1%), upper extremities (50.6%), and head (25.4%). Among injured patients, injuries spanned a mean of 1.6 body regions per patient. Mean KTS was 8.29; 61.6% had mild trauma, 22.0% moderate trauma, and 14.8% severe trauma. Transport occurred by ambulance in 48.3% of cases and by three-wheeler in 31.0%. Functional disability was common at discharge (mean WHODAS 19.9) and improved over time; however, persistent disability was observed among respondents.</p><p><strong>Conclusions: </strong>RTIs presenting to a tertiary hospital in Sri Lanka's Central Province were associated with substantial injury burden and functional disability, particularly among motorcyclists and pedestrians. These prospective data provide a foundation for local injury prevention and trauma care planning in regions outside the capital. Findings support further evaluation of prehospital transport pathways and documentation practices, and underscore the value of scalable trauma data infrastructure to enable coordinated, data-driven injury prevention and trauma care in similar LMIC settings.</p>","PeriodicalId":13967,"journal":{"name":"International Journal of Emergency Medicine","volume":"19 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13570516/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148955803","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Workplace violence as a predictor of missed nursing care in emergency departments: Findings from an analytical cross-sectional study.","authors":"Hamed Gholizad Gougjehyaran, Hossein Ebrahimi, Hadi Hasankhani, Reza Nematollahi Maleki","doi":"10.1186/s12245-026-01354-3","DOIUrl":"10.1186/s12245-026-01354-3","url":null,"abstract":"<p><strong>Background: </strong>Workplace violence is a common and significant issue in healthcare settings, particularly against emergency nurses, which compromises the quality of nursing care and can lead to the omission or delay of patient care tasks in the emergency department. Therefore, this study was conducted to examine the relationship between workplace violence and missed nursing care among emergency department nurses.</p><p><strong>Methods: </strong>A cross-sectional correlational study was conducted with 221 nurses from emergency departments of Tabriz University of Medical Sciences, selected via stratified random sampling. Data were collected using a three-part questionnaire comprising demographic information, the MISSCARE questionnaire (Part A), and the Workplace Violence in the Health Sector questionnaire. Descriptive statistics, Pearson's correlation, and multiple regression were used to analyze the data.</p><p><strong>Results: </strong>Among 221 emergency nurses, 76.0% experienced verbal violence, 32.1% experienced physical violence, and 24.9% reported threatening behaviors during the previous six months. The most frequently missed nursing care activities were patient and family education (67.9%), monitoring patients' emotional status (57.0%), and assisting with patient mobility (52.9%). Pearson correlation analysis demonstrated significant positive associations between verbal violence (r = 0.52, p < 0.001), physical violence (r = 0.38, p < 0.001), and total workplace violence (r = 0.61, p < 0.001) and missed nursing care. In the multivariable regression model, total workplace violence (B = 0.536, standardized β = 0.580, p < 0.001), work experience (B = 0.284, standardized β = 0.197, p = 0.031), and working time (B = 0.327, standardized β = 0.229, p = 0.004) were significant positive predictors of missed nursing care. The model explained 48% of the variance in missed nursing care (R² = 0.48).</p><p><strong>Conclusions: </strong>WPV is significantly associated with increased missed nursing care in emergency departments, with verbal and physical violence contributing to higher care omissions. Interventions to reduce WPV, such as violence prevention protocols and support systems, are essential to improve nursing care quality and patient safety.</p>","PeriodicalId":13967,"journal":{"name":"International Journal of Emergency Medicine","volume":"19 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13536798/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148879993","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epiploic-mesenteric knotting as a rare cause of small-bowel obstruction.","authors":"Imen Ben Ismail, Hakim Zenaidi, Marwen Sghaier, Saber Rebii, Ayoub Zoghlami","doi":"10.1186/s12245-026-01345-4","DOIUrl":"10.1186/s12245-026-01345-4","url":null,"abstract":"<p><strong>Background: </strong>Epiploic-mesenteric knotting is an exceptionally rare cause of acute small-bowel obstruction. The condition results from entanglement between the greater omentum and the small-bowel mesentery, creating a true knot that may rapidly progress to strangulation and bowel necrosis if unrecognized.</p><p><strong>Case presentation: </strong>A 56-year-old woman with no previous abdominal surgery presented with a 48-hour history of diffuse abdominal pain, distension, bilious vomiting, and cessation of stool and flatus. Examination revealed abdominal distension with diffuse tenderness and hyperactive bowel sounds. Laboratory tests were unremarkable except for a mild elevation of C-reactive protein. Contrast-enhanced computed tomography demonstrated dilated small-bowel loops with a transition point in the mid-jejunum and a whirl sign of the mesenteric vessels, consistent with a closed-loop obstruction but without an identifiable mechanical cause. Exploratory laparotomy disclosed a tight knot between the greater omentum and the jejunal mesentery, forming an epiploic-mesenteric knot. After gentle detorsion, the bowel regained normal color and peristalsis, and no resection was required. The postoperative course was uneventful, and the patient was discharged on postoperative day 5.</p><p><strong>Conclusions: </strong>Epiploic-mesenteric knotting should be considered in patients with small-bowel obstruction of unclear origin, particularly when imaging shows a closed-loop pattern or a whirl sign without an obvious cause. Because ischemia develops rapidly, early surgical exploration remains both diagnostic and lifesaving. Prompt recognition and detorsion can prevent bowel resection and ensure an excellent outcome.</p>","PeriodicalId":13967,"journal":{"name":"International Journal of Emergency Medicine","volume":"19 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13501833/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148812743","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}