Complete Gastric Transection After Blunt Force Trauma

Introduction/Purpose:
While gastric transections are a rare consequence of blunt trauma, complete tears through the thick gastric layers are even less common. The most common mechanism of injury is motor vehicle accidents followed by falls. It is postulated that the major reason for transection in these events is direct impact resulting in an increase in intraluminal pressure in the stomach, which can be further exacerbated by incomplete digestion of food. It is also thought that rapid deceleration may also contribute to this injury causing detachment of gastric ligaments. Due to its rarity and lack of significant reporting, our case of a complete gastric transection with prompt repair and successful post operative course will add to the overall body of literature documenting these injuries.


Methods or Case Description:

Our patient is a 25 year old female with no reported medical history being transported to our center from 1.5 hours away. She was involved in an MVC rollover at highway speeds and was found outside of the vehicle. She was presumed to have self-extricated due to seatbelt signs across chest and abdomen. There was at least one mortality of a passenger in the same vehicle. She was GCS 12-13 en route with stable vital signs. She received Ketamine and Fentanyl for pain control and agitation. FAST exam was negative in the trauma bay, however, she was found to have a large amount of free air on CT abd/pelvis, so she was taken emergently to the operating room. Upon exploration, she was found to have a complete transection of the gastric antrum approximately 5 cm from the pylorus, two large bowel serosal tears, and one small bowel serosal tear. There was a significant amount of undigested food particles throughout the abdominal cavity. In addition to washing out the abdomen, the gastric transection was repaired using an EEA stapler in a fashion similar to colonic end-to-end anastomosis. An anvil was placed in the distal antrum and a purse string suture was used to close the distal antrum. The proximal edges of the transected stomach was then stapled closed with a 75 green GIA. A gastrostomy was created in the body of the stomach, the EEA stapler was passed through, and the spike of the EEA was deployed through the stomach staple line. The EEA was then connected with the anvil in the distal segment. The proximal gastrostomy site was then closed using a Tx60 green load. All staple lines were oversewn and imbricated. Patient was admitted for 11 days and was started on piperacillin-tazobactam and fluconazole. She initially started as NPO with tube feeds, but ultimately she was able to advance to a regular diet prior to discharge. She was followed by a trauma surgeon closer to her home, but she followed up in our clinic 3 months after the injury and was doing well.


Outcomes:
In patients with this injury pattern, hemorrhagic shock is the most likely cause of death. Therefore, prompt diagnosis and treatment is essential to reduce mortality. Common complications include intraabdominal abscesses and sepsis with worse outcomes seen in cases where gastric contents contaminate the abdominal cavity. Overall mortality rates are highly variable and difficult to attribute solely to gastric injury due to high incidence of concomitant injuries. However, in our case, due to the relative isolation of the gastric injury, we propose that if treated promptly, these patients do fairly well.



Conclusion:

Our patient had a complete gastric transection due to blunt force trauma. Other than small serosal tears, it was an isolated injury in a situation where concomitant injury is usually present. This allowed for us to study this injury and its outcome, which is relatively lacking in the overall body of literature. We were able to promptly identify and treat this patient, and the patient has successfully recovered.