A Case of Gastric Rupture and Type IIIa Pancreatic Injury due to Abdominal Blunt Trauma

Kou Shiraishi, Shunji Mori, Kiyoshi Isobe and Takamori Nakayama

Department of Surgery, Shizuoka Red Cross Hospital

We report a very rare case of gastric rupture and complicated IIIa pattern pancreatic injury in which mortality was avoided by gastrectomy and distal-pancreas-preserving pancreatogastrostomy. A 64-year-old man seen in an emergency for abdominal blunt trauma and hematemesis after a traffic accident was found to have suspected gastric rupture due to free air and bleeding in the abdominal cavity seen in abdominal computed tomography (CT). Emergency surgery showed a gastric laceration at the lower body to the antrum and a bleeding open ulcer at the lower body near the lesser curvature, necessitating complete pancreatic transection for injury to the main pancreatic duct on the right border of the superior mesenteric vein. We conducted gastrectomy to control bleeding and pancreatogastrostomy at the distal pancreas to preserve pancreatic function. The acute-phase postoperative course was good but a slight pancreatic fistula occurred. Blood glucose and pancreas external secretion were acceptable after discharge. We found that pancreatogastrostomy was suitable in preserving the pancreas in combined gastrointestinal injury and/or massive bleeding.

Key words
gastric rupture, pancreatic injury, pancreatogastrostomy

Reprint requests
Kou Shiraishi Department of Surgery, Shizuoka Red Cross Hospital 8-2 Otemachi, Shizuoka-city, 420-0853 JAPAN

Accepted
January 22, 2003

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