Blunt Injuries of the Stomach Emmanouil Pikoulis, 1 Spiros Delis, 2 Panayiotis Tsatsoulis, 1 Ari Leppa ¨niemi, 3 Konstantinos Derlopas, 2 Georgios Koukoulides 2 and Stylianos Mantonakis 1 From the 1 2nd Department of Surgery, General Hospital“ASCLEPEION” Voulas, Athens, Greece, 2 Department of Surgery, General Hospital, Korinthos, Greece, 3 2nd Department of Surgery, University of Helsinki, HYKS, Finland Eur J Surg 1999; 165: 937–939 ABSTRACT Objective: To evaluate the results of surgical treatment of patients with blunt injuries of the stomach. Design: Retrospective study. Setting: Two general hospitals, Greece. Subjects: 10 patients operated on for blunt trauma to the stomach during a 10 year period. Main outcome measures: Hospital mortality and morbidity. Results: All patients were victims of motor vehicle accidents and presented with clinical signs warranting early laparotomy. There were 6 full-thickness, and 2 partial thickness gastric injuries located in the anterior wall. All injuries could be managed with simple surgical techniques without resections. Two patients bled to death on the operating table from associated injuries. All but one of the survivors had postoperative complications with a mean (SD) duration of hospital stay of 18(8) days (range 10–30). Conclusions: Blunt gastric injury is usually diagnosed at laparotomy for associated injuries but may occasionally be suspected from specific clinical findings. In most cases the injury is on the anterior wall. Simple repair is usually sufficient and the prognosis depends on the severity of the associated injuries. Key words: blunt trauma, stomach, perforation, surgery, motor vehicle, accident. INTRODUCTION The first successful repair of a gunshot wound to the stomach, which is attributed to Kocher, was not recorded until the late nineteenth century. Piacastelli described the first case of blunt gastric rupture in 1922(3). Gastric rupture from blunt trauma is rare and is estimated to occur in 0.4% to 1.7% of reported series (1, 2, 4, 10). Road traffic accidents are the cause in nearly 75% of the patients in whom a mode of injury is reported. Direct violence, cardiopulmonary resuscita- tion, and falls account for the remainder. The purpose of this study was to describe the collective experience of two general hospitals in managing blunt stomach injuries with special emphasis on the clinical presentation. PATIENTS AND METHODS In a retrospective review of the medical records of the past 10 years at «ASCLEPEION” General Hospital, Athens, and the General Hospital at Korinthos we identified 10 cases of gastric rupture from blunt abdominal trauma. The clinical features are sum- marised in Table I. RESULTS All patients underwent early laparotomy indicated by findings of haemodynamic instability, generalised abdominal tenderness, or blood aspirated through the nasogastric tube (n = 7), diagnostic peritoneal lavage indicating the presence of blood (n = 5), or free intraperitoneal air seen on chest radiograph (n = 1). The stomach was full in five cases. The gastric injury was a full-thickness rupture located in the anterior wall in 5, in the posterior wall or the greater curvature in one case each, and in both anterior and posterior walls in one. The ruptures ranged in size from 2 to 7 cm. A seromuscular anterior tear 6 cm long was found in one case, and a non-expanding intramural haematoma of the fundus in another. All full-thickness tears were sutured in two layers and the seromuscular tear in one layer. The intramural haematoma was treated by incision and evacuation. Two patients bled to death on the table from other injuries. All but one of the survivors had postoperative complications: subphrenic abscess (n = 2), pancreatic 1999 Scandinavian University Press. ISSN 1102–4151 Eur J Surg 165 ORIGINAL ARTICLE