This text gives the reader a starting point for acute care surgery’s most challenging and uncommon complications. It is designed to offer options to that ubiquitous intra-operative or bedside question: “Well, now what do we do with this?” The topics have been chosen because of the extreme difficulty of management, the surprising regularity they present, and the lack of a large volume of accumulated evidence, where expert experience remains vital. The volume editors present a list of clinical scenarios, intra-operative findings, and ethical circumstances that few general surgeons in their career will see in their careers. The authors represent the most prolific surgeons in practice today. They present how they wound manage these challenging acute care surgery problems based on their vast clinical experience. Here, these surgeons share their personal experiences with the most challenging cases. The text is divided into four parts. The first part is “Global Patient Issues,” when a singular surgical problem presents itself in a highly complex patient with an extensive list of unstable co-morbid diseases. The second part is “Specific Disease Issues.” This is a surgical text, and as such, each issue is an unexpected intra-operative finding and expert management. The third part is “Post-Operative Issues,” as any seasoned surgeon knows, is the most critical part of managing a complicated surgical case. The last section is “Challenging Ethical Scenarios.” The text is designed to provide the surgeon in training or the seasoned general surgeon with unique clinical or operative options for the care of their patients.
