Paediatric case of a large gastric rupture after a blunt abdominal trauma: Report of a case in a District General Hospital

Int J Surg Case Rep. 2013;4(2):235-7. doi: 10.1016/j.ijscr.2012.11.013. Epub 2012 Nov 22.

Abstract

Introduction: Isolated gastric rupture after blunt abdominal trauma is rare. In current literature gastric rupture from blunt abdominal trauma ranges between 0.02% and 1.7%. This document reports the first non-motor-vehicle case of an isolated gastric rapture after blunt abdominal injury, which repaired after early diagnosis and aggressive surgical treatment.

Presentation of case: A 14-year-old boy attended our emergency surgical department after sustained a blunt abdominal trauma following a fall from his bicycle. He presented with pain and left para-umbilical abdominal ecchymoses. Examination revealed subcutaneous emphysema and a palpable abdominal wall dimple.

Discussion: Radiological examination with CT scan determined the need for exploratory laparotomy. Operation revealed, extensive rupture of the left lateral border of the rectus abdominus muscle, free intra-peritoneal position of the nasogastric tube with gross spillage of gastric contents and pneumo-peritoneum observed with 7-8cm full thickness rupture of anterior stomach wall, from the lesser towards the greater curvature. Primary, two-layer closure was performed. On the 5th post-operative day he developed gastrorrhagia. He was discharged on the 15th postoperative day.

Conclusion: We present this case report focusing on the paediatric patient to illustrate isolated gastric injury in terms of mechanism of injury, clinical presentation, and immediate surgical management.