A Successfully Treated Case of Pediatric Traumatic Gastric Rupture Caused by Seat Belt Injury

TL;DR

A 9-year-old girl survived a rare stomach injury caused by a seat belt during a car accident and was successfully treated with surgery.

Contribution

This case highlights the importance of delayed imaging and careful monitoring in diagnosing and treating pediatric traumatic gastric rupture.

Findings

Gastric rupture was detected 44 hours after injury via contrast-enhanced CT.

Successful end-to-end gastric anastomosis was performed without gastrectomy.

The patient recovered and was discharged 27 days after the injury.

Abstract

Gastrointestinal tract injury is estimated to occur in 0.9%–1% of blunt trauma cases, with gastric rupture occurring in approximately 3% of these cases. Blunt trauma injuries of the stomach are rare. In comparison to solid organ injuries, gastrointestinal tract injuries are less likely to be accompanied by hemorrhaging that can cause hemorrhagic shock, and the process is considered to be relatively slow.

The patient was a 9-year-old girl who was involved in a passenger-seat traffic accident and transferred to the emergency room of her previous hospital. She was then referred to our institution for further evaluation and treatment after active bleeding from the gastroepiploic artery, and a suspected duodenal injury was detected on contrast-enhanced CT. Upon arrival at our hospital, her vital signs were stable, and an angiogram showed no vascular bleeding. However, her blood examination results worsened; therefore, a contrast-enhanced CT scan was performed again 44 h after the injury. A definitive perforation on the anterior wall of the stomach was noted, and injuries to the liver and spleen were suspected. Emergency laparotomy was then performed. The abdominal cavity was filled with a large amount of bilious and serous ascitic fluid. Complete transection of the stomach was identified just proximal to the pylorus in the antrum. Based on contrast-enhanced CT findings showing that the gastroduodenal artery was intact, the blood supply to the stomach stump seemed to be preserved. Therefore, we decided to perform a gastric anastomosis without gastrectomy. End-to-end anastomosis was performed. Grade I injury was also observed in the spleen, but no other organ injury was observed. The patient began eating on POD 14 and was discharged on POD 27.

During initial treatment, it is important to bear in mind that imaging studies may not always detect gastrointestinal tract injuries. Therefore, appropriate measures should be taken as necessary during subsequent treatment.

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