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1,4 Even so, only 50% to 66% of the gastric rupture cases develop enough free air to be detected by upright chest X-ray. Although upright chest X-rays can diagnose free intraperitoneal air, chest X-ray fails to identify pneumoperitoneum in a substantial amount of patients with gastric rupture because most trauma chest films are done supine. Preoperative diagnosis may be difficult, because no physical signs are specific for gastric rupture. However, as in this case, there may be scant signs of an acute abdomen if the rupture is initially contained within the lesser sac. The majority of patients with gastric rupture will present with signs of shock or abdominal tenderness. 3 A history of consuming a recent meal is common with this injury, as a distended stomach is less pliable and more likely to rupture from blunt force. pedestrian, falls, assaults, and cardiopulmonary resuscitation. 1,2 Other mechanisms include automobile vs. Motor vehicle collisions are the most common cause of gastric rupture in blunt trauma, accounting for approximately 75% of cases. Prompt and accurate diagnosis is essential to early treatment. 1,2,3 Concomitant intra-abdominal injuries contribute to a significant morbidity and mortality. Discussionīlunt gastric rupture is an uncommon entity, occurring with an incidence of 0.02% to 1.7% in blunt abdominal trauma. She was discharged from the hospital on the seventh postoperative day in good condition. The patient was extubated postoperatively. The defect was closed in 2 layers using a continuous 3-0 VICRYL (Ethicon Inc., New Brunswick, NJ) full-thickness suture for the inner layer, and 3-0 silk, interrupted, seromuscular sutures for the outer layer.
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The gastric rent was approximately 10 cm in length after adequate debridement.
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There was gross spillage of gastric contents from a 6 cm perforation along the lesser curvature of the stomach (Figure 2). The lesser sac was entered and the posterior stomach was inspected. Upon exploration, there was discoloration and fibrinous exudate along the anterior aspect of the lesser curvature of the stomach. At laparotomy, there was murky, foul-smelling fluid present. Upon return from CT scan, the patient continued to vomit, despite placement of a nasogastric tube. The posterior wall of the stomach was discontinuous with some spillage of gastric contents into the peritoneal cavity consistent with a gastric rupture (Figure 1). The CT scan of the abdomen and pelvis with intravenous contrast revealed a small focus of intraperitoneal gas anterior to the liver and a markedly dilated stomach filled with food. Blunt gastric rupture with subdiaphragmatic air, gastric dilatation, and posterior gastric wall disruption with evidence of stomach content extravasation Findings