Gastric perforation following blunt abdominal trauma

Management of Intra-abdominal Traumatic Injury

Traumatic injuries occur from unintentional and intentional violent events, claiming an estimated 4.4 million lives annually (World Health Organization). Abdominal trauma is a common condition seen in many trauma centers accounting for roughly 15% of all trauma-related hospitalizations (Boutros and colleagues 35) and is associated with significant morbidity and mortality. Following the concepts of Damage Control Resuscitation can reduce mortality drastically. Ultrasound, computed tomography scans, and routine physical examinations are used to make prompt diagnoses, trend injuries, and recognize deterioration of clinical status. Clear, effective, and closed-loop communication is essential to provide quality care.

Gastric perforation after blunt abdominal trauma: first case report in Argentina

We report the case of a 18-year-old male with gastric perforation due to blunt abdominal trauma as a result of a vehicular collision. An exploratory laparotomy with suturing of the lesion and an omental patch is performed. The post-operative outcome was favorable. Traumatic injury is a frequent cause of hospital admission to the emergency department in Argentina, and vehicle collisions are the first cause of death and permanent disability in young adults. Isolated gastric perforations following blunt abdominal are an uncommon finding, and there are only a few published cases in the literature. It is interesting to discuss the type of surgical approach.

Contrast study after gastric repair: a review of incidence, outcomes and risk factors at an adult level 1 trauma center

PURPOSE

The role of contrast study after traumatic gastric repair, continues to be controversial. To that end, we aim to review the incidence, outcomes, and risk factors of patients undergoing contrast study after traumatic gastric repair.

METHODS

This was a retrospective review of all trauma patients admitted to a level 1 trauma center that sustained gastric injuries with subsequent repair between 2011 and 2018. Demographics, surgical interventions, complications, and clinical outcomes were evaluated. Statistical analysis included Chi-square/Fisher exact univariate analysis and multivariate logistic regression analysis with a 5% significance level.

RESULTS

A total of 233 patients received a gastric repair, of whom 49 (21%) had a contrast study performed. Out of 49 patients with a contrast study, one was found to have a gastric leak. Mean time to contrast study was 6.3 ± 2.7 days. There was no statistically significant difference in post-operative complications between non-contrast and contrast study groups. Multivariate logistic regression analysis demonstrated a lack of statistical significance in clinical risk factors that would lead to obtaining a contrast study.

CONCLUSION

Gastric leak after repair is rare and there is no statistically significant difference in clinical outcomes when comparing patients who underwent contrast study to those who did not. Routine contrast study after traumatic gastric repair may not be necessary and further evidence is warranted to determine the risk factors for a selective contrast study.

Rupture of the abdominal aorta artery due to self-inflicted injuries in a young man

Introduction and importance

Case presentation

Clinical discussion

Conclusion

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Rupture of the abdominal aorta artery due to self-inflicted injuries.

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Aortic penetrating injuries have a high mortality rate.

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Rupture of the abdominal aortic artery in a patient with psychological problems and drug intoxication.

Gastric rupture following multiple blunt trauma

Gastric injury due to trauma is a rare complication that occurs in approximately 0.04%-1.2% of all instances of abdominal trauma. When imaging trauma cases, certain areas can be obscured by several inevitable reasons. Despite its rarity, the high mortality rate of a gastric injury requires an early and accurate diagnosis. We present the case of an 18-year-old male who suffered a gastric rupture of the greater curvature following a road traffic collision before providing a brief review of the literature.

A large gastric rupture due to blunt trauma: a case report and a review of the Japanese literature

Gastric rupture due to blunt trauma is rare, occurring in only 0.07-1.2% of all abdominal blunt traumas. We reported a case with a 10-cm-long hole and review 25 cases in Japan. A 22-year-old man was involved in a traffic accident, 2 h after eating a lot of food. He had suffered muscular defense in the abdomen. An abdominal computed tomography (CT) scan revealed free air, disruption of the gastric wall and a lot of food residue. The laparotomy showed a burst of 10 cm that ran parallel to the long axis from the cardia to the body. A simple closure was primarily performed and drains were placed in the abdominal cavity. The patient was discharged on the 32nd day. Most cases of gastric rupture are diagnosed intraoperatively, but careful evaluation of CT scans and patient interviews are needed to make an accurate preoperative diagnosis.

Non operative management of proximal posterior gastric injury in a trauma patient: A case report

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How to navigate the traumatic gastric injury diagnosis dilemma pre operativelly.

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Currently, a gastric leak after surgical repair is associated with significant and prolonged morbidity and mortality, remaining one of the most feared complications with no standard treatment guidelines.

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Managing traumatic GE junction injury with endoscopic stenting resulted in many advantageous including resume oral intake earlier, shorter hospital stay and less morbidities.

Introduction

Proximal postierior gastric injuries are challenging and are often overlooked and diagnosed late. We present a case of traumatic proximal posterior gastric injury.

Presentation of case

A 34-year-old male patient presented with traumatic proximal posterior gastric injury secondary to falling from a height. Nonoperative treatment was achieved by placing a gastric stent and wide drainage that resulted in complete healing of the perforation within a period of 8 weeks.

Discussion

There are no standard treatment guidelines for managing gastric leaks, except for surgical repair, in trauma patients. Management with a gastric stent has been proven effective in gastric leaks resulting from bariatric surgeries and surgical interventions for gastric cancer. This approach was followed in the management of our patient and showed promising results.

Conclusion

Nonoperative management with an endoscopic stent can be considered a treatment option for leaks resulting from traumatic gastric injury.

Combined stomach and duodenal perforating injury following blunt abdominal trauma: a case report and literature review

Background

Gastrointestinal injury following blunt abdominal trauma is uncommon; a combined stomach and duodenal perforating injury is even more rare. Because these two organs are located in different spaces in the abdomen, such injuries are difficult to identify.

Case presentation

A young woman involved in a motor vehicle crash presented to our emergency department with concerns of severe peritonitis. Contrast-enhanced computed tomography of the abdomen revealed pneumoperitoneum and retroperitoneal hematoma in zone 1. An emergency laparotomy was performed, revealing a stomach-perforating injury, which was resolved with primary repair. No obvious injury was observed on retroperitoneal exploration. However, peritonitis presented again on the second postoperative day, and a second laparotomy was performed, revealing a duodenum-perforating injury in its third portion. We performed primary repair with multi-tube-ostomy. The patient recovered well without permanent tube placement or internal bypass.

Conclusions

Assessing associated injuries in blunt abdominal trauma is crucial because they may be fatal if timely intervention is not undertaken. These types of complicated injuries require a feasible surgical strategy formulated by experienced surgeons, which gives the patient a better chance of survival.

Mesenchymal Stem Cell-injected Omental Patch More Effective Promoting Wound Healing in Bowel Perforation Animal Model

Introduction:

Bowel perforation (BP) occurs as the complication of many gastrointestinal problems. Omental patch (OP) is one of the methods to place omentum flaps in the perforated area. Mesenchymal stem cells (MSCs) may increase regeneration process in all tissues.

Aim:

to demonstrate the role of MSC in accelerating of wound healing process by analyzing fibroblast and collagen appearance in perforated bowel conditions.

Methods:

Using a BP rabbit model, 18 rabbit were randomly assigned into three groups: combination of umbilical cord (UC)-MSCs injection and OP (T1), OP only (T2) and vehicle control (Veh). Hematoxylin-eosin staining and Masson’s trichrome staining were performed to analyze the level of fibroblast and collagen. Wound length were measured using standardized caliper.

Results:

The study showed a significant (P<0.05) increase of fibroblast and collagen amount on T1 and T2, in which T1 was higher than T2. This result was also followed by the decrease of wound length.

Conclusion:

The combination of MSCs and OP-sutured in perforated bowel are better to accelerate wound healing than OP only in BP cases.