GENERAL SURGERY

 

Gastric trauma: A straightforward injury, but no room for complacency

 

 

T. E. Madiba^I; M. Hlophe^II

^IM.B. CH.B., M.MED. (CHIR.), PH.D., F.C.S. (S.A.)Department of Surgery, University of KwaZulu-Natal and King Edward VIII Hospital, Durban
^IIM.B. CH.B. Department of Surgery, University of KwaZulu-Natal and King Edward VIII Hospital, Durban

 

 

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ABSTRACT

BACKGROUND: Injuries to the stomach are common following abdominal trauma, and there are few management controversies. This study was undertaken to document experience with the management of gastric injuries in a single surgical ward in a tertiary institution.
PATIENTS AND METHODS: This prospective study was of a cohort of all patients found at laparotomy to have gastric injuries, over a 7-year period (1998 - 2004). Demographic data, clinical presentation, findings at laparotomy, and outcomes were documented. Prophylactic antibiotics were given at induction of anaesthesia. All patients found to have gastric injuries were given antifungal therapy.
RESULTS: Of the 488 patients undergoing laparotomy for abdominal trauma over this period, 99 (20%) were found to have gastric injuries, of whom 6 were female (M:F ratio 14:1). The mean age (± standard deviation (SD)) was 28.9±11.1 years. Mean delay before surgery was 7.6±5.2 hours. Seventeen patients presented in shock. Injury mechanisms were firearms (52), stabbing (43) and blunt trauma (4). The mean injury severity score (ISS) was 13.6±7.4. Forty-two patients required management in the intensive care unit (ICU), with a mean ICU stay of 4.7±4.6 hours. Twenty-nine patients developed complications, and 14 died. There was only 1 gastric injury-related complication. Causes of death were multiple organ dysfunction syndrome (MODS) (8) and hypovolaemic shock (4), septic shock (1) and renal failure (1). Patients presenting in shock had a significantly higher mortality than those without shock (p<0.0001). Delay before laparotomy did not influence outcome. There were 20 patients with isolated gastric injuries, none of whom died. Mean hospital stay was 8.8±7.7 days.
CONCLUSION: We reaffirm that stomach injuries are common following abdominal trauma. Isolated gastric injuries are uncommon. Complications specific to gastric injuries are uncommon but devastating. Mortality is related to associated injuries.

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REFERENCES

1. Brunsting LA, Morton JH. Gastric rupture from blunt abdominal trauma. J Trauma 1987; 27: 887-891.         [ Links ]

2. Espinoza R, Rodriguez A. Traumatic and non-traumatic perforation of hollow viscera. Surg Clin North Am 1997; 77: 1291-1304.         [ Links ]

3. Wilkinson AE. Injuries to the stomach. An analysis of 95 cases. S Afr J Surg 1989; 27: 59-60.         [ Links ]

4. Lawson HH. Injuries to the stomach (invited comment). S Afr J Surg 1989; 27: 60-61.         [ Links ]

5. Baker SP, O'Neill B, Haddon W et al. The injury severity score: A method for describing patients with multiple injuries and evaluating emergency care. J Trauma 1974; 14: 187-196.         [ Links ]

6. Lassandro F, Romano S, Rossi G, et al. Gastric traumatic injuries: CT findings. Eur J Radiol 2006; 59: 349-354.         [ Links ]

7. Monzon-Torres BI, Ortega-Gonzalez M. Penetrating abdominal trauma. S Afr J Surg 2004; 42: 11-13.         [ Links ]

8. Durham RM, Olson S, Weigelt JA. Penetrating injuries to the stomach. Surg Gynecol Obstet 1991; 172: 298-302.         [ Links ]

9. Madiba TE, Mokoena TR. Favourable prognosis after surgical drainage of gunshot, stab or blunt trauma of the pancreas. Br J Surg 1995; 82: 1236-1239.         [ Links ]

10. Sikhondze Wl, Madiba TE, Naidoo NM, Muckart DJJ. Predictors of outcome in patients requiring surgery for liver trauma. Injury 2007; 38: 65-70.         [ Links ]

11. Muckart DJJ, Meumann C, Botha JBC. The changing pattern of penetrating torso trauma in KwaZulu-Natal - a clinical and pathological review. S Afr Med J 1995; 85: 1172-1174.         [ Links ]

12. Petersen S, Sheldon GF, Peterson SR, Sheldon GF. Morbidity of a negative finding at laparotomy in abdominal trauma. Surg Gynecol Obstet 1979; 148: 23-26.         [ Links ]

13. Chu CC, Moncrief G. An in vitro evaluation of the stability of mechanical properties of surgical sutures in various pH conditions. Ann Surg 1983; 198: 223-228.         [ Links ]

14. Gorbach SL. Intestinal microflora. Gastroenterology 1979; 60: 1110-1129.         [ Links ]

15. Hill N. Normal and pathologgial flora of the upper gastrointestinal tract. Scand J Gastroenterol 1985; 111 (Suppl): 1-5.         [ Links ]

16. Yajko RD, Seydel F, Trimble C. Rupture of the stomach from blunt abdominal trauma. J Trauma 1975; 15: 177-183.         [ Links ]

17. Ghoshal UC, Kochhar R, Goenka MK, et al. Fungal colonisation of untreated peptic ulcer. Indian J Gastroenterol 1994; 13: 115-117.         [ Links ]

18. Madiba TE, Nair R, Mulaudzi TV, Thomson SR. Perforated gastric ulcer - reappraisal of surgical options. S Afr J Surg 2005; 43: 58-60.         [ Links ]

19. Dean DA, Burchard KW. Fungal infections in surgical patients. Am J Surg 1996; 171: 374-382.         [ Links ]

20. Peters M, Weiner J, Whelan G. Fungal infection associated with gastroduodenal ulceration: endoscopic and pathologic appearances. Gastroenterology 1980; 78: 350-354.         [ Links ]

21. Shan YS, Hsu HP, Hsieh YH, et al. Significance of intraoperative peritoneal culture of fungus in perforated peptic ulcer. Br J Surg 2003; 90: 12151219.         [ Links ]

22. Calandra T, Bille J, Schneider R, et al. Clinical significance of candida isolated from peritoneum in surgical patients. Lancet 1989; 2: 1437-1439.         [ Links ]

23. Edelman DA, White MT, Tyburski JG, Wilson RF. Factors affecting prognosis in patients with gastric trauma. Am Surg 2007; 73: 48-53.         [ Links ]