Gastric Perforations from Abdominal Trauma

Abstract

Background: Gastric rupture due to abdominal trauma is rare (0.02–1.7%); it is usually caused by traffic accidents. Delayed diagnosis, abdominal contamination and associated lesions cause morbidity and mortality. Patients and Methods: Retrospective review of 2,083 patients with abdominal traumatism treated at our center over 20 years. We reviewed recent ingestion of a meal, etiology, time to surgery, site, Stomach Injury Scale, abdominal contamination, treatment, associated injuries, complications and mortality. Results: Gastric perforation occurred in 25 patients (1.2%), median age 35 years. Stomachs were distended from recent meals in 16 (64%). The commonest causes were traffic accidents (n = 13) and blunt weapon injury (n = 7). The median time to surgery was 1 h. Gastric lesions occurred predominantly in the anterior wall (n = 12) followed by the greater curvature (n = 7). Type II lesions repaired with simple suturing were the most usual. Abdominal contamination occurred in all cases. Associated lesions were present in 22 patients; the most commonly affected intra-abdominal organ was the liver, and the lungs were the most affected extra-abdominal organ. The morbidity rate was 60% (n = 15) and the mortality rate 4% (n = 1). Conclusion: Early diagnosis and surgical treatment are important for reducing the morbidity and mortality in these patients.

Predictors of outcome in penetrating gastric injuries

“…However, 78% of all deaths between the ages of 15 and 24 years are due to trauma [27]. In our study, most patients with penetrating gastric trauma were young adult males, concurring with the findings of previous reports [14,28]. Similarly, age and sex were not associated with the outcome of penetrating gastric injury in this study.…”

“…Isolated gastric injuries due to abdominal trauma are rare; gastric injuries are usually accompanied by abdominal or extra-abdominal organ injuries [7,10,13]. As in our study, the most frequently reported accompanying injured abdominal organs are the small intestine and colon, and the most frequently injured extra-abdominal organs are the lungs and pelvis [14].…”

“…Such injuries may require more extensive debridement or a partial gastrectomy [1,3,8,14,29,30]. In addition, care must be taken regarding postoperative strictures in injuries to the gastroesophageal junction or pylorus.…”

Missed Gastric Injuries in Blunt Abdominal Trauma: Case report with review of literature

“…Tertiary surveys may detect significant injuries missed during primary and secondary surveys. 7 Gastric injuries are usually associated with a high injury severity score.…”

“…1,6−8 The most commonly affected part of the stomach is the anterior stomach wall (40% of total gastric injuries), followed by the greater (23%) or lesser (15%) curvature of the stomach and the posterior stomach wall (15%). 7 Most gastric injuries are superficial haematomas and serosal tears, whereas full thickness perforations occur less commonly (0.3%). 1 A proposed classification for traumatic gastric Patients with gastric injuries secondary to BAT usually have a nonspecific presentation, possibly due to shock; as such, abdominal tenderness or rigidity and fevers are less likely to be clinically evident.…”