10. CAMERARUIS:
1822 quien reparó una herida por florete
en el cuadrante superior izquierdo e hizo
historia por que la herida se convirtió en
una fístula gástrica cutánea con la cual
logró vivir hasta los 82 años.
Loria FL. Historical aspects of penetrating wounds of the abdomen.
Inst Abstr Surg 87:521, 1948.
11. Mikulicz realiza la primera
laparotomía exploradora en
1885 por ruptura espontánea
de estómago.
La primera operación gástrica por arma de fuego se atribuye
a Theodore Kocher.
Intervención al Presidente William McKinley quien recibe un
impacto de bala, se le somete a cirugía pero fallece a los
ocho días.
Loria FL. Historical aspects of penetrating wounds of the abdomen.
Inst Abstr Surg 87:521, 1948.
12. INCIDENCIA Y MECANISMO
Lesion gastrica de trauma penetrante 7 a 20 %
Lesion gastrica de trauma cerrado 0.4 a 1.7 %
Astudillo R et al. Trauma, Diez años de experiencia, Hospital Vicente Corral Moscoso.
Rev. Ecuatoriana de T rauma. Vol. 1 N 1. 2006
13. MORTALIDAD:
TRAUMA CERRADO:
0% - 66 % ( Media 30% )
TRAUMA ABIERTO:
14% - 20%
Shinkawa H, Yasuhara H, Nika S, et al: Characteristic features of abdominal organ injuries associated with
gastric rupture in blunt abdominal trauma. Am J Surg 187:394–397, 2004.
14. MECANISMOS DE LESION
CERRADO
- DESACELERACION
- DESCOMPRESION
- CONTUSION
ABIERTO
Fakhry S, Watts D, Daley B, et al.: Current diagnostic approaches lack sensitivity in the diagnosis of perforating blunt small bowel
injury (SBI): Findings from a large multi-institutional trial. J Trauma 51:1232, (abstract) 2001.
15. DIAGNÓSTICO
CLINICO:
- HISTORIAL DE TRAUMATISMO
SINTOMAS:
- DOLOR ABDOMINAL
-DIFICULTAD
RESPIRATORIA
- HIPO - ANOREXIA
Fakhry S, Watts D, Daley B, et al.: Current diagnostic approaches lack sensitivity in the diagnosis of perforating blunt small bowel
injury (SBI): Findings from a large multi-institutional trial. J Trauma 51:1232, (abstract) 2001.
16. SIGNOS:
- HEMATEMESIS
- CONTENIDO HEMATICO SNG
- RIGIDEZ ABDOMINAL
- TAQUICARDIA, HIPOTENSION
- IDENTIFICACION DE LESIONES
- AREA RELACIONADA
- ORIFICIOS DE ENTRADA-SALIDA
- OBJETOS PUNZO-CORTANTES
- HEMATOMAS
- LACERACIONES
- EQUIMOSIS
- EVISCERACION
Fakhry S, Watts D, Daley B, et al.: Current diagnostic approaches lack sensitivity in the diagnosis of perforating blunt small bowel
injury (SBI): Findings from a large multi-institutional trial. J Trauma 51:1232, (abstract) 2001.
17. LABORATORIO:
- LEUCOCITOSIS
- AMILASA
- ACIDOSIS METABOLICA
Fakhry S, Watts D, Daley B, et al.: Current diagnostic approaches lack sensitivity in the diagnosis of perforating blunt small bowel
injury (SBI): Findings from a large multi-institutional trial. J Trauma 51:1232, (abstract) 2001.
18. Focused Abdominal Sonography for Trauma
(FAST)
“This is not as sensitive as DPL or CT in detecting
stomach or small bowel injuries
Sensitivity 83.7% and specificity 99.7% for
detecting hemoperitoneum”
Fakhry S, Watts D, Daley B, et al.: Current diagnostic approaches lack sensitivity in the diagnosis of perforating blunt small bowel
injury (SBI): Findings from a large multi-institutional trial. J Trauma 51:1232, (abstract) 2001.
19. LAVADO PERITONEAL:
-SANGRE FRESCA o
-RECUENTO DE HEMATIES >500/mm3
ES UN INDICADOR POSITIVO NO
ESPECIFICO DE PERFORACION
INTESTINAL.
- AMILASA >20 IU/L SENSBILIDAD 54%,
ESPECIFICIDAD 48%
- FA >10 IU ESPECIFICIDAD 99.8%
SENSIBILIDAD 94.7
-WBC ≥RBC/150 SENSIBILIDAD 96.6%
ESPECIFICIDAD 99.4% despues de 3
horas de la lesion
Fang JF, Chen RJ, Lin BC: Cell count ratio: New criterion of diagnostic peritoneal lavage for detection of hollow
organ perforation. J Trauma 45: 540, 1998.
20. Fakhry S, Watts D, Daley B, et al.: Current diagnostic approaches lack sensitivity in the diagnosis of perforating blunt
small bowel injury (SBI): Findings from a large multi-institutional trial. J Trauma 51:1232, (abstract) 2001.
21. TOMOGRAFIA COMPUTARIZADA
Mas común en la evaluacion del abdomen en paciente
hemodinamicamente estables
-Traumas cerrados
- Ocasionalmente en traumas abiertos
Econtrando: fluido intraperitoneal, pneuoperitoneo,
inflamacion de grasaperitoneal, hematomas
mesentericos, extravasacion del contraste
Sensibilidad 88.3% especificidad 99.4%
Fakhry S, Watts D, Daley B, et al.: Current diagnostic approaches lack sensitivity in the diagnosis of perforating blunt
small bowel injury (SBI): Findings from a large multi-institutional trial. J Trauma 51:1232, (abstract) 2001.
22. Nicholas JM, Parker Rix E, Esley KA, et al: Changing patterns in the management of penetrating abdominal
trauma: the more things change, the more they stay the same. J Trauma 55:1095–1110, 2003.
23. Watts DD, Fakry SM: EAST Multi-Institutional Hollow Viscus Injury Research Group. Incidence of hollow viscus injury in blunt trauma:
an analysis from 275,557 trauma admissions from the EAST multi-institutional trial. J Trauma 54:289–294, 2003.
24. -EVACUACION DEL HEMATOMA
- HEMOSTASIA
- SUTURA CONTINUA 1 o 2 PLANOS
-SEDA, PROLENE 3-0 o 4-0 EXTERIOR
- ABSORBIBLE 3-0 o 4-0 INTERIOR
Watts DD, Fakry SM: EAST Multi-Institutional Hollow Viscus Injury Research Group. Incidence of hollow viscus injury in blunt
trauma: an analysis from 275,557 trauma admissions from the EAST multi-institutional trial. J Trauma 54:289–294, 2003.
25. - MISMA TECNICA POR 2 PLANOS
-USAR ENGRAPADORA GIA
- TENER CUIDADO Y PREVENIR ESTENOSIS (GE y PILORO)
Watts DD, Fakry SM: EAST Multi-Institutional Hollow Viscus Injury Research Group. Incidence of hollow viscus injury in blunt
trauma: an analysis from 275,557 trauma admissions from the EAST multi-institutional trial. J Trauma 54:289–294, 2003.
26. LESIONES EXTENSAS:
- GASTRECTOMIA PARCIAL (DISTAL – PROXIMAL) CON
GASTRODUODENO ANASTOMOSIS
- GASTRECTOMIA DISTAL CON GASTROYEYUNO
ANASTOMOSIS
- GASTRECTOMIA PROXIMAL Y ESOFAGOGASTRECTOMIA Y
PILOROPLASTIA.
Watts DD, Fakry SM: EAST Multi-Institutional Hollow Viscus Injury Research Group. Incidence of hollow viscus injury in blunt
trauma: an analysis from 275,557 trauma admissions from the EAST multi-institutional trial. J Trauma 54:289–294, 2003.