Overview

Every surgical decision begins with a patient. Not a diagram, not a classification table, and not a list of management steps, but a real person in front of you whose condition requires a reasoned, evidence-based response under time pressure and incomplete information. Clinical Scenarios in Surgery is built around that reality from the first page to the last. Authored by Dr. Nicklas M. Christoffersen, this book presents 57 complete clinical encounters across 15 surgical sections spanning the full scope of general surgery and its subspecialties. Each chapter follows an original 8-Phase Scenario Template: the clinical encounter, building the differential, confirming the diagnosis, the operative decision, inside the operating room, perioperative and ERAS care, when things go wrong, and a three-level take-home insight written separately for the medical student, the resident, and the attending surgeon. No other surgical textbook uses this structure. The clinical content is grounded in 2023 to 2025 guidelines from SAGES, ASCRS, EAST, the ERAS Society, and the ACC/AHA. Recommendations are stated with the confidence the evidence supports. Where practice is contested, that complexity is addressed directly, with the trial data and the practical answer sitting side by side. The book opens with two foundational chapters: one on surgical mindset and clinical reasoning, including cognitive bias in the operating room and shared decision-making frameworks, and one on perioperative excellence, covering the 2024 ACC/AHA cardiovascular risk guidelines, ERAS core elements, and frailty assessment. These chapters underpin every scenario that follows. From that foundation, the book works through abdominal wall surgery from the straightforward inguinal hernia through incarceration and strangulation to enterocutaneous fistula and infected mesh. Upper gastrointestinal chapters cover GERD, paraesophageal hernia, gastric cancer with neoadjuvant FLOT protocol and D2 lymphadenectomy decisions, bariatric surgery, and post-bariatric complications. Emergency general surgery chapters address acute appendicitis across the SAGES 2023 guidelines and the non-operative management debate, peptic ulcer perforation and hemorrhage, gallstone emergencies including cholelithiasis in pregnancy, bowel obstruction, diverticulitis, necrotizing soft tissue infections, and anastomotic leak management with endoscopic vacuum therapy technique. Hepatopancreatobiliary chapters cover bile duct injury from recognition through Strasberg classification and hepaticojejunostomy, liver masses using LI-RADS and BCLC staging, obstructive jaundice, pancreatitis across the step-up approach and TENSION trial evidence, and pancreatic masses from IPMN surveillance to Whipple resection. Colorectal chapters address colon and rectal cancer including the OPRA trial watch-and-wait evidence, inflammatory bowel disease, anorectal conditions, and anastomotic complications. Breast surgery, endocrine surgery, thoracic surgery, vascular surgery, pediatric surgery, surgical oncology, trauma, critical care, and transplantation each receive dedicated sections with the same depth and structure. Every chapter includes evidence-based medicine boxes, clinical pearls, operative decision frameworks, complication management scenarios, and detailed image prompts for figures and algorithms placed at the exact location where each visual belongs in the text. This book is written for medical students on surgical rotations, residents preparing for the American Board of Surgery examinations, and attending surgeons who want a case-based reference that reflects how surgical decisions are actually made.

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