Have You Ever Suspected Stercoral Perforation?: A Case Report

Diagnosis and management of abdominal pain in old age is considered a challenge to emergency physicians. Stercoral perforation is an infrequent event, which most commonly develops in old age. We report on a case of stercoral perforation in an elderly woman, which, to the best of our knowledge, is one of a few reported cases in the medical literature. A 74-year-old woman who presented at our emergency department complaining of lower abdominal pain was found to have a perforation of the colon. Examination revealed a stercoral perforation by fecaloma. She underwent Hartman's operation and colostomy. Stercoral perforation is rare; however, emergency physicians should consider this disease entity in elderly patients with abdominal pain.

How Many Emergency Physicians are Needed in Korea?

PURPOSE: Forecasting the demand for Emergency Physicians (EP) is a long, complex problem involving many variables. Although Korean Emergency Medicine Law has guidelines for the minimal numbers of EPs, it doesn't take into account the number of patients or the severity of their symptoms. Previous research involved rough estimates of the number of physicians for Emergency Departments (ED), without any consideration for workload. Our study objective was to determine whether there are an adequate number of EPs by estimating the number of EPs while considering their workload and working hours, according to the 2010 Korean Emergency Physician Survey (KEPS). METHODS: Data on the workload and working hours of Korean EPs were analyzed. The annual increase in the number of emergency patients and the annual application for residency posts were used to calculate the EP demand. Ideally, all patients must be treated by EPs; one full time equivalent (FTE) was calculated as serving 36 hours per week with two patients per hour (PPH) as the minimum. RESULTS: There were 841 EPs working in EDs and 463 EDs across Korea in 2010. A total of 635(75.5%) EPs were clinically active. EPs spent 65.6% of their working hours on clinical duty. Ideally, there should have been 2,871 FTEs and 5,797 EPs needed in 2010. CONCLUSION: There is an absolute shortage of EPs and it will get worse. The excessive hours and workloads of EPs threaten the safety of patients. Therefore, EP demand and forecasting should be focused on increasing patient coverage by EPs.