Molenat F A, Boussuges A H
Service de Réanimation Médicale et d'Hyperbarie, Hospital Salvator, Marseille, France.
Undersea Hyperb Med. 1995 Mar;22(1):87-96.
All reported cases of rupture of the stomach after a diving accident were reviewed for this study. This is a rare event that complicates brief and deep dives. It is always the consequence of equipment failure or panic reactions which induce swallowing air while under water. During a rapid ascent, the gas expands causing rupture. Diagnosis is based on the presence of abdominal distention associated with pneumoperitoneum on the x-ray and with gastric tears seen on gastroscopy. Pneumoperitoneum from gastric rupture must be distinguished from that caused by pulmonary barotrauma. Peritoneal decompression by paracentesis may quickly improve the patient's condition. After air embolism or decompression sickness has been ruled out, a surgical operation is necessary. Exploratory laparotomy exposes, in two thirds of cases, a gastric full-thickness tear that requires closing by suture. The outcome is good because subjects are young and healthy. The rupture of a filled stomach may lead to postoperative complications (abscess or fistulas).
本研究回顾了所有已报道的潜水事故后胃破裂病例。这是一种罕见事件，会使短暂而深度的潜水变得复杂。它总是设备故障或恐慌反应的结果，这些反应会导致在水下吞咽空气。在快速上升过程中，气体膨胀导致破裂。诊断基于X线显示的与气腹相关的腹胀以及胃镜检查发现的胃撕裂。胃破裂导致的气腹必须与肺气压伤引起的气腹相区分。通过腹腔穿刺进行腹膜减压可迅速改善患者状况。在排除空气栓塞或减压病后，有必要进行手术。在三分之二的病例中，剖腹探查会发现胃全层撕裂，需要通过缝合进行闭合。由于患者年轻且健康，预后良好。充满食物的胃破裂可能导致术后并发症（脓肿或瘘管）。
