Acute gastric dilation after trauma.

A prospective study of 100 trauma patients admitted to the resuscitation room was performed. Acute gastric dilatation was confirmed radiologically in 17 patients. The mechanism of injury was blunt trauma in 91 patients and penetrating in nine. The mean Injury Severity Score was 17. Of those patients with acute gastric dilatation, 13 (76%) had no abdominal injury. Acute gastric dilatation was suspected clinically in nine of 17 patients (53%) in whom the diagnosis was confirmed radiologically. Nasogastric tubes were placed in 31 patients. Fifteen patients had a diagnostic peritoneal lavage and nine of these had nasogastric aspiration before the procedure. Of 28 patients secondarily transferred from another hospital, three (11%) had undergone nasogastric intubation before transfer, five (18%) had acute gastric dilatation on admission and four (14%) had radiological evidence of pulmonary aspiration. Complications associated with acute gastric dilatation included gastric haemorrhage in six patients (35%), pulmonary aspiration in two (12%) and prolonged ileus in one (6%). Placement of a nasogastric tube in the absence of a clear contraindication, either before inter-hospital transfer or soon after admission to the resuscitation room is strongly recommended in the management of the multiply injured patient.