Gastric rupture from blunt trauma. A plea for minimal diagnostics and early surgery

This paper reviews a series of gastric perforations resulting from blunt abdominal trauma. Over an 8-year period from January 1, 1974 to December 31, 1982, a total of 1412 patients were treated for significant intra-abdominal injuries. All injuries resulted from blunt abdominal trauma. Patients were transported by helicopter to our statewide trauma center. Fourteen patients sustained 47 perforating injuries to the gastrointestinal tract; six patients (0.4%) had gastric perforations and averaged 1.3 associated intraabdominal injuries. The gastric injuries included three greater curve lacerations: one anterior wall tear, 10 cm long, extended through the esophagogastric junction, and two lacerations involved the anterior wall of the distal antrum. Five of the six patients (83.3%) complained of severe abdominal pain on admission and had bloody returns from subsequent peritoneal lavages. The sixth patient had two negative lavages 7 hours apart but underwent laparotomy for persistent symptoms. Five patients had upright chest roentgenograms, and one patient demonstrated free subdiaphragmatic air. Patients with severe abdominal pain following blunt abdominal trauma require early celiotomy. Classic diagnostic findings, e.g., free intraperitoneal air, shock, and positive paracentesis, may be absent. The gastric injuries were repaired with a two-layer technique. Two patients (33%) developed intra-abdominal sepsis and required surgical drainage. One patient required pyloroplasty and vagotomy for stress-induced gastric bleeding. All six patients survived. The high mortality of gastric perforation can be mitigated by early diagnosis and surgical intervention.