Saeb-Parsy K, Omer A, Hall N R
Department of Surgery, Addenbrooke's Hospital, Cambridge, UK.
Emerg Med J. 2006 May;23(5):e34. doi: 10.1136/emj.2005.033621.
Blunt abdominal trauma is a common cause of admission to the typical trauma centre. Hollow viscus injury from blunt trauma, however, is unusual and rarely involves the stomach. A 15 year old boy sustained a bicycle handle bar injury to the abdomen and presented to the casualty department four days later with melaena. A computed tomography (CT) scan of the abdomen showed normal findings but endoscopy revealed two "kissing" areas of mucosal ulceration on the anterior and posterior wall of the gastric antrum. The patient received a blood transfusion for anaemia but was otherwise treated conservatively and made a full recovery. The authors believe this to be the first reported case of melaena as the primary presenting symptom of gastric ulceration secondary to blunt abdominal trauma. Diagnosis of hollow viscus injuries due to blunt abdominal trauma requires a high index of suspicion and thorough investigation, particularly if the presentation is delayed.
钝性腹部创伤是普通创伤中心患者入院的常见原因。然而，钝性创伤导致的中空脏器损伤并不常见，累及胃部的情况更是罕见。一名15岁男孩腹部被自行车车把撞伤，四天后因黑便就诊于急诊科。腹部计算机断层扫描（CT）显示结果正常，但内镜检查发现胃窦前壁和后壁有两个“亲吻”状黏膜溃疡区。患者因贫血接受了输血治疗，其他方面则采取保守治疗，最终完全康复。作者认为这是首例报告的以黑便为钝性腹部创伤继发胃溃疡主要表现症状的病例。诊断钝性腹部创伤所致的中空脏器损伤需要高度的怀疑指数和全面的检查，尤其是在症状出现延迟的情况下。
