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 Table of Contents  
CASE REPORT
Year : 2014  |  Volume : 3  |  Issue : 1  |  Page : 43-44

Synchronous gastric rupture in blunt trauma to chest


Department of General Surgery, Government Medical College, Rajindra Hospital, Patiala, Punjab, India

Date of Web Publication26-Aug-2014

Correspondence Address:
Bhupinder Singla
MS General Surgery, Senior Resident, Department of General Surgery, Government Medical College Hospital, Scetor 32, Chandigarh - 160 030
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1597-1112.139473

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  Abstract 

We report a case of synchronous gastric rupture caused by blunt trauma to chest in an 8-year-old child that was successfully repaired by primary closure. In this paper, we emphasize the need for early diagnosis and the aggressive surgical treatment as a key to decreasing the mortality and morbidity from this relatively rare injury, especially in children of this age group.

Keywords: Blunt trauma chest, gastric rupture, synchronous


How to cite this article:
Singla B, Chawla I, Singh V, Singh M. Synchronous gastric rupture in blunt trauma to chest. Afr J Trauma 2014;3:43-4

How to cite this URL:
Singla B, Chawla I, Singh V, Singh M. Synchronous gastric rupture in blunt trauma to chest. Afr J Trauma [serial online] 2014 [cited 2020 Aug 12];3:43-4. Available from: http://www.afrjtrauma.com/text.asp?2014/3/1/43/139473


  Introduction Top


Synchronous gastric ruptures in cases of blunt trauma to chest are rare, with a reported incidence of 0.02-1.7%. [1] We report a case of gastric rupture caused by trauma to chest in an 8-year-old child that was successfully repaired by primary closure.


  Case Report Top


An 8-year-old male child was admitted in emergency ward with history of assault to lower side of right chest and left arm 7-days back. He got treatment from local hospital following trauma with nasogastric intubation and right side chest tube insertion. On examination, he was in shock with abdominal distension and respiratory difficulty with pain in left shoulder. Child was resuscitated vigorously. Emergency X-rays were done, which showed free air under both domes of diaphragm with right pneumothorax with right side chest tube in situ and fracture of left head of humerus [Figure 1].
Figure 1: Chest X - ray showing air under bilateral domes of diaphragm, with right side chest tube drain, and fracture of left side head of humerus

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Emergency laparotomy revealed extensive peritoneal contamination with a tear of stomach of size around 2.2 cm near lesser curvature [Figure 2]. After copious irrigation, perforation of stomach was sutured in two layers with omental patch. Drains were kept in Morrison's pouch and pelvic area. We inserted a second intercostal chest tube for right pneumothorax as the previous intercostal drainage tube was not working properly. Abscess was drained over left arm, which occurred due to infection of hematoma following trauma.
Figure 2: Gastric rupture near lesser curvature

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With extensive care, child recovered gradually. Patient developed respiratory distress again, while being admitted in ward. Chest X-ray showed left side pneumothorax with incomplete inflation of left lung. A chest tube was inserted in left lung also. Patient was then operated for fractured humerus. Later child was discharged in healthy condition.


  Discussion Top


Gastric rupture can occur in any portion of the stomach and usually occurs as a single lesion, which is commonly debrided and repaired by primary closure. [1] The anterior gastric wall is the most common site of rupture, followed by the greater curvature, [2] the lesser curvature, and the posterior wall. [1] Gastric rupture is often associated with injury to the extremities. [3] Although the blood loss from the rupture itself is generally insufficient to induce shock, patients may become hemodynamically unstable as a result of the chemical peritonitis induced by the spillage of gastric acid. [4],[5]

The synchronous trauma to abdominal organs should be kept in mind, while treating cases of blunt trauma to chest. Only early diagnosis and aggressive surgical approach can decrease mortality rates in such traumatic ruptures. [6] Free air under diaphragm in plain X-ray abdomen is seen in 16-66% of the cases of blunt chest trauma cases, with simultaneous injuries to stomach. [4],[7]

Repair of the stomach with two-layer suturing is the treatment of choice for blunt injury-associated gastric rupture. [8] The air test is useful for assessing of the integrity of the repair and searching for any untreated perforation. [2] Thorough and adequate peritoneal lavage and drainage are also necessary. [2] The mortality has been reported to range from 0-66%. [4]


  Conclusion Top


Only early diagnosis and primary surgical closure of gastric rupture can decrease the mortality caused by blunt traumas. Copious intraperitoneal irrigation and drainage are essential for the patient's survival.

 
  References Top

1.Nanji AS, Mock C. Gastric rupture resulting from blunt abdominal trauma and requiring gastric resection. J Trauma 1999;47:410-2.  Back to cited text no. 1
    
2.Ishikawa K, Ueda Y, Sonoda K, Yamamoto A, Hisadome T. Multiple gastric ruptures caused by blunt abdominal trauma: Report of a case. Surg Today 2002;32:1000-3.  Back to cited text no. 2
    
3.Shinkawa H, Yasuhara H, Naka S, Morikane K, Furuya Y, Niwa H, et al. Characteristic features of abdominal organ injuries associated with gastric rupture in blunt abdominal trauma. Am J Surg 2004;187:394-7.  Back to cited text no. 3
    
4.Courcy AP, Soderstrom C, Brotman S. Gastric rupture from blunt trauma. A plea for minimal diagnostics and early surgery. Am Surg 1984;50:424-7.  Back to cited text no. 4
    
5.Makrigiannaki E, Hatzinikolaou K, Vagdati E. Recombinant human Granulocyte-Colony-Stimulating factor (rh-G-CSF) improves neutrofil phagosytic capability, without enhancing the systemic inflammatory response in septic patients with severely impaired neutrophil function. Hippokratia 1997;1:83-92.  Back to cited text no. 5
    
6.Tu RK, Starshak RJ, Brown B. CT diagnosis of gastric rupture following blunt abdominal trauma in a child. Pediatr Radiol 1992;22:146-7.  Back to cited text no. 6
    
7.Siemens AR, Fulton LR. Gastric rupture as a result of blunt trauma. Am Surg 1977;43:229-33.  Back to cited text no. 7
    
8.Pikoulis E, Delis S, Tsatsoulis P, Leppäniemi A, Derlopas K, Koukoulides G, et al. Blunt injuries of the stomach. Eur J Surg 1999;165:937-9.  Back to cited text no. 8
    


    Figures

  [Figure 1], [Figure 2]



 

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Abstract
Introduction
Case Report
Discussion
Conclusion
References
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