Dr Deepak Varma Gastro Surgeon Cochin

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Injury or trauma to the stomach

Injury or trauma to the stomach can be blunt or penetrating injuries. They cause damage to the abdominal organs causing rigidity, external abdominal bruising, pain and tenderness. Abdominal trauma comes with the risk of infection and blood loss.

Blunt abdominal trauma

The three mechanisms by which blunt abdominal trauma are explained are:

  • Rapid deceleration: The rapid deceleration mechanism can cause shifting of adjoining structures.
  • Classic deceleration: Injuries to renal arteries, hepatic tear mostly along the ligamentum teres; intrabdominal contents are crushed.
  • External compression: The abdomen sustains a blow from a fixed object such as a seat belt.

Causes of blunt abdominal trauma

  • Vehicular collision
  • Auto to pedestrian collisions
  • Industrial accidents
  • Falls and recreational accidents

Signs and symptoms of blunt trauma

  • Gastrointestinal haemorrhage
  • Pain
  • Tenderness
  • Peritoneal irritation
  • Hypovolemia

Diagnosis of blunt trauma

  • Physical examination will reveal:
    • Seat belt marks
    • Steering wheel contusions
    • Abdominal distention
    • Auscultation bowel sounds indicating diaphragmatic injuries
    • Abdominal bruit
    • Crepitation of thoracic cage
  • Other:
    • Diagnostic peritoneal lavage
    • FAST examination
    • CT scan

Penetrating abdominal trauma

The abdominal cavity is violated due to stab wounds or gunshot wounds. They require different methodologies of treatment.

Diagnosis of penetrating abdominal trauma

  • Initial assessment:
    • Airway, breathing and circulation
    • Vital signs
    • Level of disability neurological deficits are assessed
    • Location of wounds
    • Exposure of wounds
    • Examination of all body surfaces
    • Type of object
    • Volume of blood loss
  • Imaging tests:
    • Chest radiography
    • Abdominal radiography 2 views
    • Ultrasonography chest and abdomen
    • Abdominal CT scan triple-contrast helical CT
    • Brain CT scan
    • Skeletal survey

Injuries to stomach, either blunt or penetrating are uncommon. The most common symptom of stomach injury is peritonitis (abdominal pain, rigidity and in later stages features of sepsis). The investigation of choice for this condition is a CT scan of the abdomen. This shows free gas in the abdominal cavity. Traumatic tear of the stomach requires immediate surgical repair. A small clean tear or hole in the stomach can be repaired by closing it with stitches and keeping a feeding tube to administer enteral feeds. Complex or major tears may require removal of part or the entire stomach, which is a much more major operation.

We manage trauma patients after a thorough consideration of formalities. He observes the mechanism and location of the injury and patient neurological status before administering treatment.

Authored by Dr. Deepak Varma, MBBS, MS (General Surgery)

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