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Vela J, Contreras C, Varas J, Ottolino P, Ramos JP, Escalona G, Diaz A, Achurra P, Ceroni M. Transgastric repair of transfixing gastroesophageal junction gunshot wound: video case report. J Surg Case Rep 2021; 2021:rjab160. [PMID: 34046158 PMCID: PMC8140550 DOI: 10.1093/jscr/rjab160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 04/02/2021] [Indexed: 12/04/2022] Open
Abstract
Managing traumatic injuries of the gastroesophageal junction (GEJ) is infrequent due to associated lesions of adjacent highly vascularized organs. Its anatomical localization in the upper abdomen makes the repair challenging to perform. A stable 23-year-old male was presented at the emergency department with two thorax gunshot wounds. Computed tomography revealed air in the periesophageal space and right hemopneumothorax with no injury of the major vessels. A chest tube was placed and the patient was transferred hemodynamically stable to the operating. Abdominal exploration identified injuries to the left diaphragm; liver lateral segment; 1-cm transfixing perforation of the GEJ and right diaphragmatic pillar. Primary repair of the GEJ was performed and patched with a partial fundoplication. The diaphragm was repaired and the liver bleeding controlled. Finally, drains and a feeding jejunostomy were placed. The patient had an uneventful early postoperative course and was discharged home on the 12th postoperative day.
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Affiliation(s)
- Javier Vela
- Surgery Department, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Caterina Contreras
- Surgery Department, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Julián Varas
- Surgery Department, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Pablo Ottolino
- Surgery Department, Complejo Asistencial Dr. Sótero del Río, Santiago, Chile
| | - Juan Pablo Ramos
- Surgery Department, Complejo Asistencial Dr. Sótero del Río, Santiago, Chile
| | - Gabriel Escalona
- Surgery Department, Complejo Asistencial Dr. Sótero del Río, Santiago, Chile
| | - Alfonso Diaz
- Surgery Department, Complejo Asistencial Dr. Sótero del Río, Santiago, Chile
| | - Pablo Achurra
- Surgery Department, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Marco Ceroni
- Surgery Department, Complejo Asistencial Dr. Sótero del Río, Santiago, Chile
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Ueda S, Okamoto N, Seki T, Matuyama T. A large gastric rupture due to blunt trauma: a case report and a review of the Japanese literature. J Surg Case Rep 2021; 2021:rjaa521. [PMID: 33569160 PMCID: PMC7853660 DOI: 10.1093/jscr/rjaa521] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 11/20/2020] [Indexed: 11/13/2022] Open
Abstract
Gastric rupture due to blunt trauma is rare, occurring in only 0.07-1.2% of all abdominal blunt traumas. We reported a case with a 10-cm-long hole and review 25 cases in Japan. A 22-year-old man was involved in a traffic accident, 2 h after eating a lot of food. He had suffered muscular defense in the abdomen. An abdominal computed tomography (CT) scan revealed free air, disruption of the gastric wall and a lot of food residue. The laparotomy showed a burst of 10 cm that ran parallel to the long axis from the cardia to the body. A simple closure was primarily performed and drains were placed in the abdominal cavity. The patient was discharged on the 32nd day. Most cases of gastric rupture are diagnosed intraoperatively, but careful evaluation of CT scans and patient interviews are needed to make an accurate preoperative diagnosis.
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Affiliation(s)
- Shiro Ueda
- Department of Emergency and Critical Care Medicine, Nara Prefecture General Medical Center, Nara 630-8581, Japan
| | - Noritomo Okamoto
- Department of Emergency and Critical Care Medicine, Nara Prefecture General Medical Center, Nara 630-8581, Japan
| | - Tadahiko Seki
- Department of Emergency and Critical Care Medicine, Nara Prefecture General Medical Center, Nara 630-8581, Japan
| | - Takeshi Matuyama
- Department of Emergency and Critical Care Medicine, Nara Prefecture General Medical Center, Nara 630-8581, Japan
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Poelmann FB, IJpma FFA. Blunt abdominal injury resulting in a belly full of candy after a motocross accident, a case report. BMC Surg 2020; 20:325. [PMID: 33298005 PMCID: PMC7727190 DOI: 10.1186/s12893-020-00997-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 12/01/2020] [Indexed: 11/10/2022] Open
Abstract
Background Blunt traumatic gastric perforations in children are rare. Delayed diagnosis will lead to abdominal contamination and may result in morbidity and even mortality. We present a case of an adolescent who sustained blunt abdominal injury in a motocross accident and presented with remarkable hyperdense spherical shaped structures on the computed tomography (CT). Case presentation A 15-year-old boy arrived at the emergency room with an acute abdomen after a motocross accident. A CT scan of the abdomen demonstrated free air and hyperdense round structures in the stomach, pelvic cavity and right paracolic gutter. During emergency laparotomy a traumatic gastric perforation was sutured, a splenic rupture was treated with a vicryl mesh and multiple spherical food scraps were removed from the abdomen. After surgery, the boy clarified that he had eaten a whole bag of colorful and spherical shaped candy just before the accident. Conclusions Traumatic gastric rupture in children is rare but physicians should be aware of this diagnosis in case of blunt abdominal trauma with free air on the CT scan. Gastric contents, in this case candy, can present as hyperdense shaped structures in the abdominal cavity on the CT scan.
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Affiliation(s)
- Floris B Poelmann
- Department of Trauma Surgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.
| | - Frank F A IJpma
- Department of Trauma Surgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
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Abstract
Gastroduodenal perforation may be spontaneous or traumatic and the majority of spontaneous perforation is due to peptic ulcer disease. Improved medical management of peptic ulceration has reduced the incidence of perforation, but still remains a common cause of peritonitis. The classic sub-diaphragmatic air on chest x-ray may be absent and computed tomography scan is a more sensitive investigation in the stable patient. The management of perforated peptic ulcer disease is still a subject of debate. The majority of perforated peptic ulcers are caused by Helicobacter pylori, so definitive surgery is not usually required. Perforated peptic ulcer is an indication for operation in nearly all cases except when the patient is asymptomatic or unfit for surgery. However, non-operative management has a significant incidence of intra-abdominal abscesses and sepsis. Primary closure is achievable in traumatic perforation, but the management follows the Advanced Trauma Life Support (ATLS) principles.
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Affiliation(s)
- Elroy Patrick Weledji
- Department of Surgery, Faculty of Health Sciences, University of Buea, Buea, Cameroon
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Ibrahim AH, Osman AJ, Alarfaj MA, Alzamil AM, Abahussain MA, Alghamdi H. Case report: Evisceration of abdomen after blunt trauma. Int J Surg Case Rep 2020; 72:207-211. [PMID: 32544830 PMCID: PMC7298532 DOI: 10.1016/j.ijscr.2020.05.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 04/21/2020] [Accepted: 05/21/2020] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Abdominal evisceration is uncommon after blunt abdominal trauma; therefore, it warrants urgent laparotomy. We report a young adult male who sustained multiple injuries due to a high impact mechanism resulting in blunt abdominal injury and underwent numerous laparotomies. CASE REPORT In a high-speed motorcycle accident, a twenty-six-year-old male sustained a direct, blunt injury to his abdomen, which resulted in a right hemothorax, perforation of the stomach, and small bowel. Multiple mesenteric vessels tear, a retroperitoneal hematoma, liver, and pancreatic injury. The abdominal wall split transversely, extruding intact bowel. After resuscitation, according to the ATLS protocol, the patient underwent eight laparotomies for damage control. After 45 days in the Surgical Intensive Care Unit, then 11 days in the surgical ward, he was discharged in a satisfactory condition. Eight months later, he was admitted electively for ileostomy reversal, which was uneventful. CONCLUSION Patients with high trauma mechanisms have high mortality and morbidity rate. Blunt injury with eviscerated abdominal contents requires prompt, expeditious, and timely intervention, particularly at the initial operative intervention with damage control procedures, both prompt management and structured approach, were tailored depending in the magnitude of the injury. A multidisciplinary approach is mandatory throughout the period of treatment until recovery and rehabilitation.
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Affiliation(s)
- Arwa H Ibrahim
- College of Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Saudi Arabia.
| | - Adel J Osman
- King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Department of Surgery, Saudi Arabia
| | - Mosab A Alarfaj
- King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Department of Surgery, Saudi Arabia
| | - Areej M Alzamil
- College of Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Saudi Arabia
| | - Munirah A Abahussain
- College of Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Saudi Arabia
| | - Hanan Alghamdi
- King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Department of Surgery, Saudi Arabia
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Defining the gastroesophageal junction in trauma: Epidemiology and management of a challenging injury. J Trauma Acute Care Surg 2017; 83:798-802. [PMID: 28538646 DOI: 10.1097/ta.0000000000001563] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Injuries to the gastroesophageal (GE) junction are infrequently encountered because of the high mortality of associated injuries. Consequently, there is a paucity of literature on the patient demographics and treatment options. The aim of this study was to examine the epidemiology, surgical management, and outcomes of these rare injuries. METHODS Patients presenting to LAC + USC Medical Center (January 2008 to August 2016) with traumatic esophageal or gastric injury (DRG International Classification of Diseases-9th Rev.-Clinical Modification and 10th Rev. codes) were extracted from the trauma registry. Patient charts were reviewed, and all patients who sustained an injury to the GE junction were enrolled. Patient demographics, injury characteristics, procedures, and outcomes were analyzed. RESULTS Of the 238 patients who sustained an injury to the esophagus or stomach during the study period, 28 (12%) were found to have a GE junction injury. Mean age was 26 years (range, 14-57 years), 89% male. Mechanism of injury was penetrating in 96% (n = 27), the majority of which were gunshot wounds (n = 22, 81%). Most patients (n = 18, 64%) were taken directly to the operating room. Ten (36%) underwent computed tomography scan before going to the operating room, all demonstrating a GE junction injury. All patients underwent repair via laparotomy. One (4%) also required thoracotomy to facilitate delayed reconstruction. GE junction injuries were typically managed with primary repair (n = 22, 79%). Associated injuries were frequent (n = 26, 93%), and injury severity was high (mean Injury Severity Score, 25 [9-75]). Mortality was 25% (n = 7), and all patients required intensive care unit admission. Most did not require total parenteral nutrition (n = 25, 89%) or a surgically placed feeding tube (n = 26, 93%). Of the 13 patients who presented for clinical follow-up, all but one (n = 12, 92%) were eating independently by the first clinic visit. CONCLUSION GE junction injuries are uncommon and occur almost exclusively after penetrating trauma. Patients are severely injured with a high mortality rate and frequently have associated intracavitary injuries. Most can be fixed through the abdomen alone and do not require thoracotomy for repair. Despite the severity of injuries, the majority of survivors are eating independently by the first clinic visit. LEVEL OF EVIDENCE Epidemiological, level V.
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Nonmalignant gastric causes of acute abdominal pain on MDCT: a pictorial review. Abdom Radiol (NY) 2017; 42:101-108. [PMID: 27480975 DOI: 10.1007/s00261-016-0854-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Acute abdominal pain is a common indication for imaging. The stomach may be poorly assessed or overlooked on multidetector computed tomography (MDCT), despite the high prevalence of gastric pathology as the source of abdominal pain. We review the pathophysiology, imaging features, and clinical management of common and uncommon nonmalignant gastric conditions on MDCT. As the stomach is often difficult to assess on MDCT, and pathology overlooked, corresponding increased awareness of gastric causes of pain is critical for radiologists to accurately interpret imaging in the setting of acute abdominal pain.
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Naiem AA, Taqi KM, Al-Kendi BH, Al-Qadhi H. Missed Gastric Injuries in Blunt Abdominal Trauma: Case report with review of literature. Sultan Qaboos Univ Med J 2016; 16:e508-e510. [PMID: 28003902 DOI: 10.18295/squmj.2016.16.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2016] [Revised: 06/07/2016] [Accepted: 06/30/2016] [Indexed: 11/16/2022] Open
Abstract
Hollow viscus injuries of the digestive tract are an uncommon occurrence in blunt abdominal trauma. We report a 39-year-old male who was hit by a vehicle as a pedestrian and admitted to the Sultan Qaboos University Hospital, Muscat, Oman, in 2015. He underwent an exploratory laparotomy which revealed injuries to the distal stomach, liver and descending colon. Postoperatively, the patient was febrile, tachycardic and hypotensive. Abdominal examination revealed distention and tenderness. The next day, a repeat laparotomy identified a gastric injury which had not been diagnosed during the initial laparotomy. Although the defect was repaired, the patient subsequently died as a result of multiorgan failure. Missed gastric injuries are rare and are associated with a grave prognosis, particularly for trauma patients. Delays in diagnosis, in addition to associated injuries, contribute to a high mortality rate.
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Affiliation(s)
- Ahmed A Naiem
- General Surgery Residency Program, Oman Medical Specialty Board, Muscat, Oman
| | - Kadhim M Taqi
- General Surgery Residency Program, Oman Medical Specialty Board, Muscat, Oman
| | - Badriya H Al-Kendi
- General Surgery Residency Program, Oman Medical Specialty Board, Muscat, Oman
| | - Hani Al-Qadhi
- Department of Surgery, Sultan Qaboos University Hospital, Muscat, Oman
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Affiliation(s)
- J. E. Dechant
- Department of Surgical and Radiological Sciences; School of Veterinary Medicine; University of California-Davis; USA
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Taguchi H, Arai T, Ohta S. Gastric rupture. Gastroenterology 2010; 138:e3-4. [PMID: 20189482 DOI: 10.1053/j.gastro.2009.07.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2009] [Revised: 07/02/2009] [Accepted: 07/08/2009] [Indexed: 12/02/2022]
Affiliation(s)
- Hirokazu Taguchi
- Emergency and Critical Care Medicine, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
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Rodríguez-Hermosa JI, Roig-García J, Gironès-Vilà J, Ruiz-Feliú B, Ortiz-Ballujera P, Ortiz-Durán MR, Codina-Cazador A. Gastric necrosis: a possible complication of the use of the intragastric balloon in a patient previously submitted to nissen fundoplication. Obes Surg 2009; 19:1456-9. [PMID: 19506987 DOI: 10.1007/s11695-009-9855-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2009] [Accepted: 04/27/2009] [Indexed: 10/20/2022]
Abstract
The temporary use of the bioenterics intragastric balloon in morbid obesity is increasing worldwide. Generally, this is an effective procedure that helps bring about satisfactory weight loss and improvement in comorbidities after 6 months. However, in some cases, it causes complications such as acute abdomen due to gastric perforation and even death. We describe the case of a type II obese female (weight, 88 kg; body mass index, 35.2 kg/m(2)) who underwent emergency surgery for gastric necrosis caused by bioenterics intragastric balloon; the patient required total gastrectomy and intensive care.
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