Gastric trauma: a straightforward injury, but no room for complacency.

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.