Case contribution: Dr. Radhiana Hassan
Clinical:
- An 11 years old boy, fall from his bicycle
- Presented with pain at left hypochondriac region, clinically guarded abdomen
- Vital signs are normal
- Blood investigations are also normal
CT scan findings:
- Multiple air pockets are seen within the peritoneal cavity (yellow arrow)
- No obvious bowel discontinuity is seen
- Normal bowel wall enhancement
- No dilated bowel loops.
- Liver, spleen, kidney and pancreas are normal
Intra-operative findings:
- Operation showed a 2 cm perforation at body of stomach
- The perforation site is about 2 cm from lesser curvature.
- Small amount of contamination is seen in the peritoneal cavity.
- Small and large bowels are normal.
- Omental patch done.
Diagnosis: Gastric perforation from blunt abdominal trauma
Discussion:
- Gastric perforation following blunt abdominal trauma is usually associated with other intra or extra abdominal injury.
- isolated gastric perforation in blunt abdominal trauma is rare.
- The incidence is between 0.02% to 1.7%.
- It may occur in any location of stomach. The most common location is anterior wall (40%), greater curvature (23%), lesser curvature (15%) and posterior wall (15%).
- Ultrasonography has poor sensitivity to detect bowel injury. however it has value in identifying free intra-abdominal fluid which is a non-specific finding.
- Computed tomography is the imaging modality of choice.
- Unexplained intraperitoneal fluid, pneumoperitoneum, bowel abnormalities prompt further intervention including exploratory laparotomy.
- The surgical management of gastric injury depends on the grade of injury.
Progress of patient:
- Discharged day 5 post op.
- Recovered fully.
- Review 6 months later patient was well
