Stomach Trauma

Stomach Trauma

David Ray Velez, MD

Table of Contents

Background
Presentation and Diagnosis
Treatment

Background

Etiology

  • Most Common in Penetrating Trauma
  • Less Common in Blunt Trauma Due to the Thick Wall
    • Unless the Stomach is Full, there is a High Blunt Force, or Seat Belts are Worn Improperly

In Blunt Stomach Injuries, there are Often Concomitant Injuries to Other Organs in the Abdomen or Chest Due to the High Blunt Force Required

Mechanism of Injury

  • Penetrating Mechanisms:
    • Direct Injury – Tearing & Crushing Force Through Tissue Along the Trajectory of the Projectile & its Fragments
      • Gunshot Wounds Have an Additional Dissipation of Kinetic Energy That Causes Further Damage
    • Cavitation – As a High Energy Projectile Moves Through Tissue Energy Causes a Radial Stretching, Forming a Temporary Cavity with Additional Tissue Damage
      • Higher Energy Projectiles Create Larger Cavities & Cause More Damage
    • Shock Wave – The Projectile Creates Rapid Changes in Pressure & Temperature that Propagate Through Tissue Causing Additional Injury
  • Blunt Mechanisms:
    • Crushing Force – Direct Compression Causing Injury
    • Shearing Force – Tearing from Acceleration/Deceleration Around Fixed Attachments
    • Bursting Force – Force Causing Acutely Increased Intraluminal Pressure within Hollow Organs Leading to Rupture

Traumatic Stomach Perforation 1

Presentation and Diagnosis

Presentation

  • Mostly Nonspecific
  • Abdominal Pain
  • Chest Pain
  • Nausea and Vomiting
  • Hematemesis
  • NG/OG Tube with Bloody Aspirate

May Be Diagnosed on CT or Intraoperatively

AAST Stomach Injury Grade

Treatment

Anterior Wounds Should Mandate Exploration of the Lesser Sac to Inspect for Posterior Wounds (Incise the Gastrocolic Ligament to Enter the Lesser Sac)

Any Hematoma After Penetrating Trauma Should Be Opened and Explored to Evaluate for Occult Injury Beneath

Simple Laceration/Perforation: Primary Repair vs. Wedge Resection

  • One-Layer Repair: Use Nonabsorbable Suture
  • Two-Layer Repair: Inner Absorbable, Outer Nonabsorbable

Significant Tissue Loss/Devascularization: Partial Gastrectomy and Reconstruction (Billroth I/II vs. Roux-en-Y)

  • If Too Severe to Reconstruct: Total Gastrectomy and Roux-en-Y Esophagojejunostomy

Delay to Surgery with Perforation is Associated with Increased Morbidity and Mortality

Reconstruction After Partial Gastrectomy

References

  1. Angelopoulos S, Mantzoros I, Kyziridis D, Fontalis A, Parpoudi S, Konstandaras D, Tsalis C. A rare case of a transabdominal impalement after a fall from a ladder. Int J Surg Case Rep. 2016;22:40-3. (License: CC BY-NC-ND-4.0)