International Journal of Emergency Medicine最新文献

{"title":"The term Wellens syndrome should be extended to include inferior and posterior wall coronary artery disease: a case report.","authors":"András Simon, Zsófia Nagy, Zoltán Járai","doi":"10.1186/s12245-026-01322-x","DOIUrl":"10.1186/s12245-026-01322-x","url":null,"abstract":"<p><strong>Background: </strong>According to current terminology, Wellens syndrome's electrocardiographic (ECG) signs are present in leads V2-3 and indicate a critical proximal left anterior descending coronary artery (LAD) stenosis, suggesting an impending anterior myocardial infarction. This case report highlights that the Wellens pattern can be observed in localisations other than the anterior leads, and that the underlying pathomechanism of Wellens syndrome is not specific to the LAD.</p><p><strong>Case presentation: </strong>An 83-year-old female patient with high cardiovascular risk presented to the emergency department with symptoms characteristic of Wellens syndrome. However, the Wellens pattern appeared in the ECG leads representing the inferior and posterior walls. Urgent coronary angiography confirmed a 99% ostial stenosis of the dominant right coronary artery, which was successfully treated with a drug-eluting stent.</p><p><strong>Conclusions: </strong>We suggest extending the Wellens syndrome terminology to include inferior and posterior wall coronary artery disease, based on electrocardiographic abnormalities in locations other than the anterior, if the clinical presentation corresponds.</p>","PeriodicalId":13967,"journal":{"name":"International Journal of Emergency Medicine","volume":"19 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13430899/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148669316","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":"Cocaine-induced PRES in a previously normotensive patient: a case report and review of literature.","authors":"Akshayaa Kumar Aggarawal, Aniruddh Shailesh Shringare, Mansoor Gazi","doi":"10.1186/s12245-026-01323-w","DOIUrl":"https://doi.org/10.1186/s12245-026-01323-w","url":null,"abstract":"<p><strong>Background: </strong>Posterior reversible encephalopathy syndrome (PRES) is a clinicoradiological condition characterized by acute neurological manifestations and vasogenic cerebral oedema, typically affecting the parieto-occipital regions. Although acute hypertension is the most identified precipitating factor, the role of illicit substances such as cocaine is increasingly recognized yet remains underreported.</p><p><strong>Case presentation: </strong>We describe a case of a 30-year-old white female admitted with generalized tonic-clonic seizure associated with a hypertensive crisis (210/130 mmHg), followed by acute visual disturbance. Initial non-contrast computed tomography of the brain raised concern for bilateral occipital infarction; however, subsequent magnetic resonance imaging revealed bilateral symmetrical vasogenic oedema without diffusion restriction, consistent with a diagnosis of PRES. Urine toxicology screening was positive for cocaine metabolites. The patient achieved complete neurological and visual recovery following prompt blood pressure control and initiation of antiepileptic therapy. A follow up MRI showed near complete resolution of previously noted hyperintensities.</p><p><strong>Conclusion: </strong>This case underscores cocaine-induced PRES as an important differential diagnosis in young patients presenting with seizures, severe hypertension, and posterior circulation imaging abnormalities. Early recognition is crucial to prevent misdiagnosis as acute ischemic stroke and to avoid potentially irreversible neurological sequelae.</p>","PeriodicalId":13967,"journal":{"name":"International Journal of Emergency Medicine","volume":"19 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149297299","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}

{"title":"Rapidly progressive Ludwig's angina following self-extraction of a tooth with a nail: a Cannot-Intubate Possible-to-Ventilate scenario managed with LMA bridge to surgical tracheostomy - a case report.","authors":"Shallo Alemu Gemeda, Tirsit Endaylalu Worku, Tilaye Tadesse Haile, Getahun Jiru Bedada, Mekonnen Biruk Teklemariam","doi":"10.1186/s12245-026-01331-w","DOIUrl":"10.1186/s12245-026-01331-w","url":null,"abstract":"<p><strong>Background: </strong>Ludwig's angina is a rapidly progressive, potentially fatal polymicrobial cellulitis of the submandibular and sublingual spaces, most commonly of odontogenic origin. Airway compromise may develop within hours, and securing the airway represents the most critical initial intervention. Lemierre's syndrome, septic thrombophlebitis of the internal jugular vein, may complicate deep neck infections and carries significant morbidity. We present a case in which both conditions converged with an extreme difficult airway scenario, managed according to Difficult Airway Society (DAS) guidelines in resource limited setting.</p><p><strong>Case presentation: </strong>A 34-year-old previously healthy man presented with a 3-day history of rapidly progressive bilateral neck swelling, high-grade fever, dysphagia, drooling of saliva and respiratory distress after self-extracting a right lower molar tooth with a nail one week prior. On arrival, he had severe trismus, stridor, drooling, tachypnea to 40 breaths per minute and an oxygen saturation of 78% on room air. Direct laryngoscopy failed and video laryngoscopy was not available. A second-generation laryngeal mask airway (LMA) was successfully placed, establishing a Cannot Intubate, Possible to Ventilate (CIPV) scenario. Cricothyroidotomy was attempted but anatomically not feasible due to massive neck swelling. The patient was transferred immediately to the operating room where a surgical tracheostomy was performed while LMA ventilation was maintained. He subsequently developed septic shock, peri-procedural cardiac arrest with initial asystole converting to ventricular tachycardia (VTac) with wide-complex morphology requiring 200 J defibrillation after one CPR cycle and achieving return of spontaneous circulation. Ultrasound and CT of the neck confirmed Lemierre's syndrome with left internal jugular vein thrombosis.</p><p><strong>Conclusion: </strong>This case illustrates the lethal potential of rapidly progressive Ludwig's angina, underscores the importance of early structured airway management following DAS guidelines, and highlights Lemierre's syndrome as a serious complication of deep neck infection. LMA can be a life-saving bridge in the CIPV scenario when front-of-neck access fails.</p>","PeriodicalId":13967,"journal":{"name":"International Journal of Emergency Medicine","volume":"19 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13422294/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148630383","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":"Toward diagnostic precision and context-adaptive therapy in prehospital supraventricular tachycardia.","authors":"Jay Prakash, Tonny Veenith, Bram Rochwerg, Kalavathy Swarna","doi":"10.1186/s12245-026-01317-8","DOIUrl":"10.1186/s12245-026-01317-8","url":null,"abstract":"<p><p>The recent scoping review by Gamberini et al. provides a comprehensive overview of the prehospital diagnosis and management of supraventricular tachycardia (SVT), while highlighting substantial heterogeneity in diagnostic accuracy, therapeutic strategies, and emergency medical service (EMS) practices. In this Matter Arising, we build upon their work by discussing key challenges and opportunities for advancing prehospital SVT care. We emphasize the importance of improving diagnostic precision through telemedicine-enabled electrocardiogram interpretation and emerging artificial intelligence-assisted decision support, strengthening implementation of evidence-based non-pharmacological interventions such as the modified Valsalva manoeuvre, optimizing adenosine use based on evolving evidence, and considering the implications of variations in EMS systems and international guideline recommendations. We further highlight the need to interpret existing evidence in the context of temporal heterogeneity, predominantly observational data, and differences in prehospital care models. Future research should focus on prospective multicentre studies, standardized outcome reporting, and implementation strategies that support precision-guided, context-adaptive prehospital SVT management.</p>","PeriodicalId":13967,"journal":{"name":"International Journal of Emergency Medicine","volume":"19 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13421730/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148630304","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":"Low-volume body bag cooling for severe exertional heat stroke in the emergency department: a case report.","authors":"Takao Ikeda, Taketo Watase, Takashiro Kondo, Hiroko Watase, Tomohiro Funabiki, Mitsunaga Iwata","doi":"10.1186/s12245-026-01321-y","DOIUrl":"10.1186/s12245-026-01321-y","url":null,"abstract":"<p><strong>Background: </strong>Exertional heat stroke (EHS) is a life-threatening emergency in which delayed or inadequate cooling substantially increases the risk of death and permanent neurological injury. Core temperature reduction to below 39 °C within 30 min is the therapeutic target, and cold-water immersion achieves the fastest cooling rates (0.15-0.35 °C/min) but is frequently unavailable in emergency departments (ED) due to equipment and space limitations. Body bag-based tarp-assisted cooling with oscillation (TACO) has been proposed as an alternative using universally available materials; however, clinical evidence supporting its emergency department use remains limited.</p><p><strong>Case presentation: </strong>A 57-year-old immunocompromised male construction worker (acute myeloid leukemia, status post umbilical cord blood transplantation, maintained on prednisolone and tacrolimus) presented with EHS following 90 min of outdoor labor in ambient conditions of 36 °C and 65% relative humidity. On ED arrival, rectal temperature was 42.0 °C, Glasgow Coma Scale score was 4, blood pressure was 125/80 mmHg, and heart rate was 183 beats/minute. Body bag-based TACO was initiated immediately upon arrival using 15 L of tap water and 15 kg of ice. Endotracheal intubation for airway protection was performed concurrently, demonstrating patient accessibility during cooling. Target temperature (rectal temperature < 39 °C) was achieved in 39 min at a cooling rate of 0.085 °C/min. Glasgow Coma Scale score improved to 14 within 7.5 h of admission. The hospital course was complicated by bacteremia requiring prolonged antimicrobial therapy. The patient was discharged ambulatory on hospital day 42 without neurological sequelae.</p><p><strong>Conclusions: </strong>Body bag-based TACO required substantially less water (15 L) than the water/ice volumes reported in TACO studies (114-151 L) using materials available in any ED. Although the cooling rate achieved (0.085 °C/min) fell below published benchmarks, the patient achieved complete neurological recovery, suggesting that immediate initiation of cooling may help offset a suboptimal rate. While a single case cannot establish equivalence to cold-water immersion, body bag-based TACO offers a practical, low-cost option for initiating cooling when standard infrastructure is unavailable, and merits further comparative evaluation.</p>","PeriodicalId":13967,"journal":{"name":"International Journal of Emergency Medicine","volume":"19 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13700194/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149266885","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":"Trauma scoring systems for evaluating trauma center triage criteria in older adults: a retrospective cohort study.","authors":"Małgorzata Sulej-Niemiec, Andrzej Kopta, Magdalena Żurowska-Wolak, Łukasz Kręglicki, Mirosław Szura","doi":"10.1186/s12245-026-01315-w","DOIUrl":"10.1186/s12245-026-01315-w","url":null,"abstract":"<p><strong>Background: </strong>Standardized trauma assessment is essential for early clinical decision-making; however, it remains challenging in older adults because age-related physiological changes may obscure injury severity. Accurate triage is critical to ensure timely access to trauma centers (TCs). While triage decisions must rely on immediately available clinical findings, advanced trauma scoring systems are typically based on diagnostic data obtained later in the course of care. Although these tools are not suitable for real-time triage, they are established predictors of mortality and may provide an objective basis for evaluating TC qualification criteria. Because current national TC qualification criteria do not adequately account for age-specific factors, they may contribute to undertriage in older patients. This study aimed to retrospectively identify the trauma scoring system most suitable for evaluating TC qualification criteria in geriatric trauma patients.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of patients admitted to the emergency department of a single clinical hospital with a TC between 2017 and 2020. Among 155,320 ED admissions, 6,541 trauma patients aged ≥ 65 years were identified. Injury severity and physiological status were assessed using the coded Revised Trauma Score (RTSc), Injury Severity Score (ISS), and Trauma and Injury Severity Score (TRISS). A predefined subgroup of patients meeting national TC qualification criteria (TC group 65+) was analyzed separately. Predictive performance for in-hospital mortality was evaluated using receiver operating characteristic (ROC) curve analysis.</p><p><strong>Results: </strong>TRISS showed the highest discrimination for in-hospital mortality (AUC 0.888), followed by ISS (0.867) and RTSc (0.687). In the TC group 65+, the mean TRISS-predicted survival probability was 34.58%, whereas observed in-hospital survival was 48.72%. The estimated undertriage rate was 73.47%, suggesting that current national TC qualification criteria may perform inadequately in older trauma patients.</p><p><strong>Conclusion: </strong>Current national TC qualification criteria may contribute to undertriage among older patients, potentially delaying access to advanced trauma care. Among the evaluated scoring systems, TRISS demonstrated the highest discriminatory performance for in-hospital mortality and appears to be the most suitable retrospective reference standard for assessing TC qualification criteria in geriatric trauma patients.</p>","PeriodicalId":13967,"journal":{"name":"International Journal of Emergency Medicine","volume":"19 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13700330/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149266807","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":"Low-flow time and neurological outcomes in out-of-hospital cardiac arrest: implications for prehospital care quality and health outcomes.","authors":"Shang-Chiao Yang, Yi-Chang Chou, Yu-Hsiang Chen, Yi-Jin Hu","doi":"10.1186/s12245-026-01314-x","DOIUrl":"10.1186/s12245-026-01314-x","url":null,"abstract":"<p><strong>Background: </strong>Out-of-hospital cardiac arrest (OHCA) remains a significant public health challenge with high mortality and morbidity. Low-flow time (LFT) is an important determinant of outcomes, yet the specific temporal thresholds for functional recovery across different cardiac rhythms remain poorly defined in metropolitan Asian settings. This study aimed to identify the optimal LFT cut point for predicting survival and favorable neurological outcomes using a large-scale emergency medical services (EMS) registry.</p><p><strong>Methods: </strong>This retrospective cohort study analyzed 4,933 adult non-traumatic OHCA cases from the Taoyuan City EMS registry between January 2021 and October 2025. The primary exposure was LFT, defined as the duration from the initiation of CPR to hospital handover or return of spontaneous circulation. Multivariable logistic regression was utilized to evaluate the independent association between LFT and survival to discharge. Optimal LFT thresholds were identified using Receiver Operating Characteristic (ROC) curves and the Youden Index, stratified by initial cardiac rhythm (shockable vs. non-shockable).</p><p><strong>Results: </strong>The overall survival rate to discharge was 22.8% (n = 1,123). A significant rhythm-specific divergence in the impact of LFT was observed. In the shockable rhythm group, LFT exceeding 27 minutes was independently associated with increased mortality (Adjusted Odds Ratio [AOR]: 2.25; 95% CI: 1.19-4.27; p = 0.013). The optimal LFT threshold for predicting survival to discharge was 27 minutes (AUC 0.58; Sensitivity 41%, Specificity 72%), while the threshold for favorable neurological outcome was 26 minutes. In contrast, LFT was not a significant independent predictor for the non-shockable rhythm group (AUC 0.52; p > 0.05), where outcomes were likely dominated by non-temporal factors.</p><p><strong>Conclusion: </strong>Among OHCA patients presenting with shockable rhythms, a low-flow time of approximately 27 minutes was associated with survival and favorable neurological outcomes. However, given the modest predictive performance of this threshold, it should be interpreted as a supportive reference rather than a definitive clinical cutoff. These findings highlight the potential value of incorporating rhythm-specific temporal information into prehospital decision-making, EMS resource allocation, and future evaluations of termination-of-resuscitation protocols.</p>","PeriodicalId":13967,"journal":{"name":"International Journal of Emergency Medicine","volume":"19 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13422270/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148619892","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":"Penetrating neck injury with concealed glass foreign body transfixing the skull base: a case report of a diagnostic trap.","authors":"Changhua Yang, Jiewei Liu, Jianjian Xue","doi":"10.1186/s12245-026-01330-x","DOIUrl":"10.1186/s12245-026-01330-x","url":null,"abstract":"<p><strong>Background: </strong>Penetrating neck injuries (PNIs) caused by glass carry high mortality due to occult deep penetration, transparency of foreign bodies, and bleeding‑induced obscuration. External absence of visible glass often misleads clinicians to underestimate injury severity and omit preoperative imaging, creating a life‑threatening diagnostic trap. This case uniquely clarifies that prolonged preoperative hypotension (SBP < 60 mmHg for ≥ 2 h), rather than vascular repair strategy, is the decisive factor for irreversible cerebral injury.</p><p><strong>Case presentation: </strong>A 34‑year‑old man fell 1.9 meters onto broken glass, sustaining a 13.0 cm left posterior neck penetrating wound with no externally visible glass. Despite pre‑transfer transfusion, he arrived in hemorrhagic shock (BP 52/32 mmHg, Hb 51 g/L, lactate 8.1 mmol/L), with preoperative hypotension (SBP <60 mmHg) lasting more than 2.5 hours before hemostasis. Non‑contrast CT identified a 10.5 cm × 3.0 cm hyperdense glass fragment transfixing the skull base to the maxillary sinus with comminuted fractures. CT angiography showed complete non‑opacification of the left internal carotid artery, internal jugular vein, and sigmoid sinus. Emergency surgery removed the foreign body and ligated the lacerated internal carotid artery to achieve hemostasis. Postoperatively, the patient remained comatose; imaging confirmed diffuse cerebral ischemia and herniation. He died after family refusal of further intervention.</p><p><strong>Conclusion: </strong>In PNIs, absence of visible glass externally does not rule out deep transfixing injury. Early non‑contrast CT is mandatory to avoid diagnostic errors. In patients with major cervical vascular disruption and hemorrhagic shock, prolonged preoperative hypotension (SBP <60 mmHg ≥2 hours) predicts irreversible global cerebral ischemia unresponsive to successful hemostasis. Emergency physicians must prioritize early CT and expedite definitive hemorrhage control.</p><p><strong>Clinical trial number: </strong>Clinical trial number: not applicable.</p>","PeriodicalId":13967,"journal":{"name":"International Journal of Emergency Medicine","volume":"19 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13712057/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149266831","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":"Bowel ischemia following extracorporeal cardiopulmonary resuscitation (ECPR): case reports and narrative review.","authors":"Yanzhu Chen, Shaoyan Mo, Minghan Deng, Hanwen He","doi":"10.1186/s12245-026-01327-6","DOIUrl":"10.1186/s12245-026-01327-6","url":null,"abstract":"<p><strong>Background: </strong>Extracorporeal cardiopulmonary resuscitation (ECPR) is a life-saving strategy for refractory cardiac arrest (CA), but the mortality rate is still high. Bowel ischemia is associated with the clinical outcomes, and few studies on bowel ischemia following ECPR have been reported.</p><p><strong>Methods: </strong>We reported 2 cases of bowel ischemia following ECPR. And we searched literature to describe the incidence, clinical features, and outcomes of bowel ischemia following ECPR. Demographic features, risk factors, clinical features, diagnostic methods, treatment and outcome were analyzed.</p><p><strong>Results: </strong>We described 2 patients developed bowel ischemia with recurred hematochezia at different phases post ECPR, conservative treatments were not effective, one patient received colectomy after extracorporeal membrane oxygenation (ECMO) weaning and recovered, and the other died without surgery. Our literature search found 3 publications. Non-occlusive mesenteric ischemia(NOMI) was more common for bowel ischemia following ECPR, and the incidence of NOMI in ECPR patients seemed higher than that in conventional CPR patients. Postmortem findings demonstrated signs of bowel ischemia within hours of ECPR. The incidence of bowel ischemia following ECPR could not be identified due to the variability among the studies.</p><p><strong>Conclusion: </strong>Bowel ischemia may initiate early post ECPR, or occur insidiously during the therapeutic process, thus clinicians should have a high suspicion and low threshold for CT scan and endoscopy. Surgical timing for advanced bowel ischemia should be individualized.</p>","PeriodicalId":13967,"journal":{"name":"International Journal of Emergency Medicine","volume":"19 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13700263/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149266866","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":"Idiopathic pneumoperitoneum: two cases with possible association to elevated intraluminal pressure.","authors":"Shuling Wang, Xing Zhang, Wei Li, Jinlong Zhao, Li He, Ning Yang, Qiwei Zhao, Yang Wang, Jianwei Ma, Jian Zhang, Yihao Song, Fei Xu, Zhongxin Li","doi":"10.1186/s12245-026-01309-8","DOIUrl":"10.1186/s12245-026-01309-8","url":null,"abstract":"<p><strong>Background: </strong>Pneumoperitoneum is an uncommon condition characterized by free gas in the abdominal cavity, usually resulting from gastrointestinal (GI) tract perforation and requiring emergency surgery. Idiopathic pneumoperitoneum is a rare condition with no identifiable cause and might be managed conservatively in stable patients without peritonitis signs.</p><p><strong>Case presentation: </strong>We report two cases of idiopathic pneumoperitoneum diagnosed by Computed tomography (CT) scan without obvious evidence of GI perforation. The etiology remains unclear, the more plausible explanation would be that increased intraluminal or intra-abdominal pressure induced by intestinal obstruction or constipation may contribute to occult micro perforation or mucosal disruption, which may not be detectable on contrast-enhanced CT imaging. The patients exhibited varied clinical presentations and responded well to conservative management, with complete clinical recovery.</p><p><strong>Conclusions: </strong>This report aims to emphasize the diagnostic challenges in differentiating idiopathic pneumoperitoneum from surgically urgent causes of pneumoperitoneum and to advocate for an appropriate approach to conservative management in stable patients, even when CT imaging demonstrates free intraperitoneal gas.</p>","PeriodicalId":13967,"journal":{"name":"International Journal of Emergency Medicine","volume":"19 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13689287/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149238236","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}