n South African Journal of Surgery - Gastric trauma : a straightforward injury, but no room for complacency : general surgery




. 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.

. 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.
. 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.
. 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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