Cho In Soo, Park Chan Hee, Lee Jeong Woo
Division of Trauma Surgery and Surgical Critical Care, Department of Surgery, Keimyung University School of Medicine, Dongsan Medical Center, Daegu 42601, South Korea.
World J Clin Cases. 2025 Jun 16;13(17):98529. doi: 10.12998/wjcc.v13.i17.98529.
Motorcycle accidents often result in abdominal trauma in patients seeking emergency care. Injuries to the hollow viscera, including the duodenum, jejunum, urinary bladder, and colorectum, are relatively common. In contrast, owing to the protective function of the anterior rib cage, gastric rupture is exceptionally rare, with an incidence of < 1.7%. Gastric rupture typically occurs in the anterior wall and rarely presents as multiple ruptures. This report describes an unusual case of multiple gastric ruptures resulting from blunt trauma.
A 21-year-old man, who was involved in a motorcycle collision at 70 km/hour after consuming a large meal, presented with hypotension. Physical examination revealed abdominal tenderness. Laboratory test results indicated elevated amylase, lipase, and liver enzyme levels. Computed tomography showed pneumoperitoneum, hemoperitoneum, and gastric wall discontinuation, suggesting gastric perforation alongside pancreatic, splenic, and hepatic injuries. Angiographic embolization was performed because of active contrast leakage in the left gastric and right gastroepiploic arteries. Emergency laparotomy revealed substantial blood loss, hematoma, and gastric contents scattered throughout the abdominal cavity. Two 10 cm gastric perforations in the anterior and posterior walls were identified, as well as severe liver damage, splenic injury, and pancreatic contusion. Surgical interventions included primary closure of the gastric wall, splenectomy, and partial hepatectomy. After temporary abdominal closure, the patient underwent a second surgery without further bleeding. The gastric repair site was resected and reinforced for optimal tissue healing.
Gastric rupture following blunt trauma is fatal. However, patients without severe complications can recover through surgical interventions and postoperative care.
在寻求急诊治疗的患者中，摩托车事故常导致腹部创伤。包括十二指肠、空肠、膀胱和结肠直肠在内的中空脏器损伤相对常见。相比之下，由于前侧肋骨的保护作用，胃破裂极为罕见，发生率<1.7%。胃破裂通常发生在前壁，很少表现为多处破裂。本报告描述了一例因钝性创伤导致多处胃破裂的罕见病例。
一名21岁男性，在饱餐后以70公里/小时的速度发生摩托车碰撞，出现低血压。体格检查发现腹部压痛。实验室检查结果显示淀粉酶、脂肪酶和肝酶水平升高。计算机断层扫描显示气腹、血腹和胃壁连续性中断，提示胃穿孔伴胰腺、脾脏和肝脏损伤。由于胃左动脉和胃网膜右动脉有造影剂外渗，进行了血管造影栓塞术。急诊剖腹手术显示大量失血、血肿，胃内容物散落在整个腹腔。在前壁和后壁发现两个10厘米的胃穿孔，以及严重的肝损伤、脾损伤和胰腺挫伤。手术干预包括胃壁一期缝合、脾切除术和部分肝切除术。临时关闭腹腔后，患者再次手术且未再出血。切除并加固胃修复部位以促进最佳组织愈合。
钝性创伤后胃破裂是致命的。然而，没有严重并发症的患者可通过手术干预和术后护理康复。
