Therapeutic attitude in perforated stress ulcer

There are medical conditions where the etiology is not at the level of digestive system, but as a result of a distant lesion, determined by head trauma. The latter is a severe impact on the whole body, not only locally; it produces damages in the gastro-duodenal area mainly as acute stress ulcer.

Our study includes 4 cases of patients with multiple trauma, admitted in the "St. Pantelimon" Emergency Hospital, where, despite medication, they subsequently developed stress ulcer (Cushing ulcer). Laboratory tests were followed in the development the level of leukocytes, ESR(erythrocyte sedimentation rate) and abdominal ultrasound. Around the fifth day it was observed that the level of the leukocytes were high (between 15000-20000/microl).

ESR between 40-70mm/hour and ultrasound showed fluid in peritoneal cavity, mainly in subhepatic space (Morison's pouch). A positive radiological result highlight the crescent transparency (mesogastric pneumoperitoneum) in dorsal decubitus position, lateral incidence (pacients that could not be mobilised and the radiologic exam was made in intensive care bed). On the group of four patients studied with multiple trauma and Cushing ulcer perforation, it was laparoscopically intervined in order to reduce the negativ effects of combined anesthesic and surgical trauma on an already fragile status.

The study showed that emergency laparoscopy in patients with multiple trauma is a successful approach in it's minimally invasivity, being a diagnosis and therapeutic first option in acute abdominal conditions in these patients.