Clinical Topics
High-yield acute care surgery organized around real surgical problems rather than textbook chapters.
VISUAL SURGERY • CLINICAL JUDGMENT • OPERATIVE DECISIONS
Acute Care Surgery.
Acute Care Surgery.
See it. Decide. Operate.
A different kind of ACS learning experience: begin with the call, read the image, commit to a decision, then move into the operating room and beyond.
THE ACS ENGINE
01The Call
02Read the Image
03Make the Decision
04In the OR
17cases matched to your ACS clinical image archive
Visual Diagnosis
Clinical, radiologic and operative images that ask you to commit before the diagnosis is revealed.
Operative Findings
What the surgeon sees, what it means, and how the operative plan changes in real time.
Case Challenges
Progressive surgical judgment with board-style reinforcement after each case.
THE ACS VAULT
Eight clinical domains. Twenty-eight decision cases.
Choose a domain or enter any case. Cases with matching images from your historical ACS archive are marked as visual cases and are prioritized first.
Acute AbdomenVISUAL CASE
Appendiceal Mucocele
Matched to: mucocele 4.png
OPEN DECISION CASE →Acute AbdomenDECISION CASE
Meckel's Diverticulitis
Meckel's diverticulitis chapter
OPEN DECISION CASE →Emergency Imaging FindingsVISUAL CASE
Pneumoperitoneum
Matched to: Free air 1.png
OPEN DECISION CASE →Emergency Imaging FindingsDECISION CASE
Pneumobilia
Pneumobilia chapter
OPEN DECISION CASE →Infection & SepsisVISUAL CASE
Necrotizing Soft Tissue Infection
Matched to: necrotizing soft tissue infection.jpg
OPEN DECISION CASE →Emergency Imaging FindingsVISUAL CASE
Pneumatosis Intestinalis
Matched to: pnematosis.jpg
OPEN DECISION CASE →GI HemorrhageVISUAL CASE
GI Bleeding — Upper / Lower
Matched to: dielaufoy.jpg
OPEN DECISION CASE →Obstruction & IschemiaVISUAL CASE
Small Bowel Obstruction
Matched to: SBO.jpg
OPEN DECISION CASE →Acute AbdomenDECISION CASE
Small Bowel Perforation
Small bowel perforation chapter
OPEN DECISION CASE →Acute AbdomenDECISION CASE
Small Bowel Diverticulitis
Small bowel diverticulitis chapter
OPEN DECISION CASE →Acute AbdomenDECISION CASE
Enterocutaneous Fistula
Enterocutaneous fistula chapter
OPEN DECISION CASE →Acute AbdomenDECISION CASE
Diverticulitis
Diverticulitis chapter
OPEN DECISION CASE →Emergency Imaging FindingsDECISION CASE
Portal Venous Gas
Portal venous gas chapter
OPEN DECISION CASE →Acute AbdomenVISUAL CASE
Acute Appendicitis
Matched to: CT scan of appendicitis.jpg
OPEN DECISION CASE →Hepatobiliary & PancreasDECISION CASE
Acute Cholecystitis
Cholecystitis chapter
OPEN DECISION CASE →Hepatobiliary & PancreasDECISION CASE
Acute Cholangitis
Cholangitis chapter
OPEN DECISION CASE →Obstruction & IschemiaVISUAL CASE
Toxic Megacolon
Matched to: Toxic Megacolon CT.jpg
OPEN DECISION CASE →Infection & SepsisVISUAL CASE
Fournier's Gangrene
Matched to: fournieres2.jpg
OPEN DECISION CASE →Obstruction & IschemiaVISUAL CASE
Cecal Volvulus
Matched to: Cecal volulus CTScan.png
OPEN DECISION CASE →Infection & SepsisVISUAL CASE
Fecal Peritonitis
Matched to: fecal peritonitis.bmp
OPEN DECISION CASE →HerniasVISUAL CASE
Paraesophageal Hernia
Matched to: paraesophageal hernia 2.jpg
OPEN DECISION CASE →HerniasDECISION CASE
Incarcerated Ventral Hernia
Incarcerated ventral hernia material
OPEN DECISION CASE →HerniasVISUAL CASE
Incarcerated Groin Hernia
Matched to: inc femoral hernia 2.jpg
OPEN DECISION CASE →Obstruction & IschemiaVISUAL CASE
Bowel Ischemia / Necrosis
Matched to: bowel ischemia.jpg
OPEN DECISION CASE →Anorectal EmergenciesVISUAL CASE
Hemorrhoids
Matched to: Necrotic thrombosed hemorrhoid.jpg
OPEN DECISION CASE →Obstruction & IschemiaDECISION CASE
Sigmoid Volvulus
Sigmoid volvulus material
OPEN DECISION CASE →Hepatobiliary & PancreasVISUAL CASE
Pancreatic Pseudocyst
Matched to: pancreatic pseudocyst.jpg
OPEN DECISION CASE →Obstruction & IschemiaVISUAL CASE
Intussusception
Matched to: Target sign.png
OPEN DECISION CASE →INTERACTIVE CASE VAULT
Train the decision, not just the diagnosis.
Visual cases appear first, followed by the remainder of the complete ACS decision library.
Operative Judgment CaseARCHIVE VISUALReal ACS source image mapped to this case.
Acute Appendicitis
A classic migrating-pain presentation that moves from bedside recognition to imaging interpretation and operative strategy.
OPEN DECISION CASE →Operative Judgment CaseARCHIVE VISUALReal ACS source image mapped to this case.
Appendiceal Mucocele
A cystic appendiceal lesion may represent benign obstruction or mucinous neoplasm; operative handling must minimize rupture and mucin spillage.
OPEN DECISION CASE →Operative Judgment CaseARCHIVE VISUALReal ACS source image mapped to this case.
Acute Anorectal Emergencies
Acute anorectal pain most commonly narrows quickly to fissure, abscess or thrombosed external hemorrhoid, but the exam determines which.
OPEN DECISION CASE →Operative Judgment CaseARCHIVE VISUALReal ACS source image mapped to this case.
Pneumatosis Intestinalis
Gas in the bowel wall can be benign or a marker of transmural ischemia. The decision depends on physiology, examination, lactate, enhancement and associated portal venous gas—not the image alone.
OPEN DECISION CASE →Operative Judgment CaseARCHIVE VISUALReal ACS source image mapped to this case.
Pneumoperitoneum
Free intraperitoneal air is a radiographic finding, not a diagnosis. The learner must combine the image with peritonitis, physiology, recent procedures and the likely source.
OPEN DECISION CASE →Operative Judgment CaseARCHIVE VISUALReal ACS source image mapped to this case.
GI Bleeding — Upper / Lower
Major GI hemorrhage is a physiology-first problem: stabilize the patient, determine whether the source is upper or lower, localize active bleeding and escalate from endoscopy to angiography or surgery when necessary.
OPEN DECISION CASE →Operative Judgment CaseARCHIVE VISUALReal ACS source image mapped to this case.
Pancreatic Pseudocyst
Size alone does not mandate intervention; symptoms, complications, maturity, debris and duct anatomy should drive treatment.
OPEN DECISION CASE →Operative Judgment CaseARCHIVE VISUALReal ACS source image mapped to this case.
Incarcerated Groin Hernia
A painful irreducible groin mass with bowel obstruction forces the surgeon to distinguish incarceration from strangulation and decide when reduction is unsafe.
OPEN DECISION CASE →Operative Judgment CaseARCHIVE VISUALReal ACS source image mapped to this case.
Paraesophageal Hernia
Chronic dysphagia and early satiety can become an acute gastric-volvulus emergency when obstruction or strangulation develops.
OPEN DECISION CASE →Operative Judgment CaseARCHIVE VISUALReal ACS source image mapped to this case.
Fecal Peritonitis
Gross enteric contamination is the endpoint of multiple ACS diseases; the operative problem is rapid source control in a physiologically threatened patient.
OPEN DECISION CASE →Operative Judgment CaseARCHIVE VISUALReal ACS source image mapped to this case.
Fournier's Gangrene
A rapidly progressive perineal infection demands recognition of necrotizing disease, immediate resuscitation and wide operative debridement.
OPEN DECISION CASE →Operative Judgment CaseARCHIVE VISUALReal ACS source image mapped to this case.
Necrotizing Soft Tissue Infection
A rapidly progressive soft-tissue infection where delay in operative source control can be catastrophic.
OPEN DECISION CASE →Operative Judgment CaseARCHIVE VISUALReal ACS source image mapped to this case.
Adult Intussusception
In an adult with obstruction and a CT target sign, the key question is the pathologic lead point and whether bowel is threatened.
OPEN DECISION CASE →Operative Judgment CaseARCHIVE VISUALReal ACS source image mapped to this case.
Bowel Ischemia / Necrosis
The learner must recognize when abnormal bowel enhancement, pneumatosis or operative discoloration represents threatened or dead bowel and when delay becomes dangerous.
OPEN DECISION CASE →Operative Judgment CaseARCHIVE VISUALReal ACS source image mapped to this case.
Cecal Volvulus
A distended patient with large-bowel obstruction challenges the learner to recognize volvulus, distinguish cecal from sigmoid disease, and move to definitive operative treatment before ischemia develops.
OPEN DECISION CASE →Operative Judgment CaseARCHIVE VISUALReal ACS source image mapped to this case.
Small Bowel Obstruction
A prior-operation patient with vomiting and obstipation forces the key ACS distinction: simple adhesive obstruction versus threatened bowel.
OPEN DECISION CASE →Operative Judgment CaseARCHIVE VISUALReal ACS source image mapped to this case.
Toxic Megacolon
A critically ill patient with acute colitis and colonic dilation tests the boundary between aggressive medical therapy and timely surgery.
OPEN DECISION CASE →Operative Judgment CaseDECISION CASECommit before the teaching is revealed.
Acute Diverticulitis
The key decision is not whether diverticulitis exists, but whether abscess, free perforation, fistula, obstruction or sepsis changes management.
OPEN DECISION CASE →Operative Judgment CaseDECISION CASECommit before the teaching is revealed.
Enterocutaneous Fistula
The first operation for an enterocutaneous fistula is often not an operation at all: stabilize, control sepsis and effluent, protect skin, define anatomy and rebuild nutrition before definitive reconstruction.
OPEN DECISION CASE →Operative Judgment CaseDECISION CASECommit before the teaching is revealed.
Meckel's Diverticulitis
Meckel's disease can mimic appendicitis, bleed, obstruct or perforate; diagnosis often becomes clear only during exploration.
OPEN DECISION CASE →Operative Judgment CaseDECISION CASECommit before the teaching is revealed.
Small Bowel Diverticulitis
Jejunal or ileal diverticulitis can imitate other acute-abdomen diagnoses and may progress to abscess or perforation.
OPEN DECISION CASE →Operative Judgment CaseDECISION CASECommit before the teaching is revealed.
Small Bowel Perforation
A perforated small bowel is a source-control problem first; the cause matters, but it must not delay definitive treatment.
OPEN DECISION CASE →Operative Judgment CaseDECISION CASECommit before the teaching is revealed.
Pneumobilia
Central biliary air is a finding, not a diagnosis: distinguish expected post-procedural air from gallstone ileus, infection, and fistula.
OPEN DECISION CASE →Operative Judgment CaseDECISION CASECommit before the teaching is revealed.
Portal Venous Gas
Peripheral hepatic gas plus a toxic abdominal presentation should trigger urgent evaluation for intestinal ischemia and necrosis.
OPEN DECISION CASE →Operative Judgment CaseDECISION CASECommit before the teaching is revealed.
Acute Cholangitis
Biliary infection becomes an emergency when obstruction and sepsis coexist; the learner must recognize that antibiotics alone are not source control.
OPEN DECISION CASE →Operative Judgment CaseDECISION CASECommit before the teaching is revealed.
Acute Cholecystitis
A patient with persistent right upper quadrant pain, fever and inflammatory findings moves from ultrasound recognition to safe operative strategy.
OPEN DECISION CASE →Operative Judgment CaseDECISION CASECommit before the teaching is revealed.
Incarcerated Ventral Hernia
An acutely painful irreducible ventral hernia becomes an ACS emergency when it causes obstruction or compromises bowel perfusion.
OPEN DECISION CASE →Operative Judgment CaseDECISION CASECommit before the teaching is revealed.
Sigmoid Volvulus
Sigmoid volvulus differs from cecal volvulus because a viable, nonperforated sigmoid can often be endoscopically decompressed first, followed by definitive resection during the same admission.
OPEN DECISION CASE →