Blunt gastric rupture: a plural clinical presentation and literature review

Abstract

Blunt trauma is still the leading mechanism of trauma found in patients admitted to trauma centres worldwide. In these patients, the gastric injury is a very rare lesion, occurring in less than 2% of all blunt traumas. Besides the low incidence, gastric rupture mortality is high, which makes the diagnosis an essential step. Thus, this study aims to report two blunt gastric injuries, with different clinical features, prompting the discussion about the main features of clinical suspicion and diagnosis, besides the main therapeutic approaches. Therefore, this study can alert the medical community to the quick diagnosis and assertive therapy, saving patients of unwelcome endpoints.

Keywords: gastroenterology; gastrointestinal surgery; general surgery; trauma.

Figure 1

Mode B ultrasound at Morrison space (Focused Assessment with Sonography for Trauma protocol) showing fluid presence in the cavity (white arrow).

Figure 2

Abdominal CT (the late portal phase) showing pneumoperitoneum and free fluid (*); grade II spleen injury (S); gastric wall thickening (white arrow).

Figure 3

Abdominal CT for pneumoperitoneum assessment, enhanced by the use of lung window (black arrow).

Figure 4

Abdominal CT (the late portal phase) showing the iliac fracture and muscular and fat thickening, associated with local haematoma.

Figure 5

Gastric posterior wall injury.

Figure 6

(A) Two planes gastrorraphy final aspect (white arrow); (B) splenectomy product—spleen injury at the superior pole (*).

Figure 7

Abdominal CT (arterial phase) showing a grade V spleen injury (A), with active bleeding evidenced by the ‘blush’ (white arrow) and the presence of free fluids at Morison’s space and peri-splenic space (late portal phase) (B).