This document discusses gastric injuries from penetrating and blunt trauma. It provides details on the history of gastric surgery, mechanisms of injury, clinical signs and symptoms, diagnostic tests like CT scans, surgical repair techniques like suturing or partial gastrectomies. Gastric injuries have a mortality rate of 14-20% for penetrating trauma and 0-30% for blunt trauma. Diagnosis can be challenging and may require exploratory laparotomy.

2. CAMERARUIS:
St. Martín en 1822 quien recibió 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.

3. Mikulicz realiza la primera laparotomía
exploradora en 1885 por ruptura espontánea
de estómago, el desenlace fue fatal
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 con relación de las heridas
gástricas, pero el paciente fallece a los ocho
días.
Loria FL. Historical aspects of penetrating wounds of
the abdomen. Inst Abstr Surg 87:521, 1948.

4. Lesion gastrica de trauma penetrante 7 a 20 % 5to lugar frecuencia
Lesion gastrica de trauma cerrado 0.4 a 1.7 % (únicamente 75 casos)
Astudillo R et al. Trauma, Diez años de experiencia, Hospital Vicente Corral Moscoso. Rev.
Ecuatoriande T rauma. Vol. 1 N 1. 2006

5. MORTALIDAD:
TRAUMA CERRADO:
0% - 66 % ( Media 30% )
TRAUMA ABIERTO:
14% - 20%
Shinkawa H, Yasuhara H, Nika S, et al: Characteristic features of
bdominal organ injuries associated with gastric rupture in blunt
abdominal trauma. Am J Surg 187:394–397, 2004.

6. Netter, F.H. Atlas de Anatomía Humana. Cuarta edición. Elsevier-
Masson, 2007, 2009

7. Organo abdominal intratorácico
Medios de fijación laxos (4)
Bien protegido por estructuras
viscerales y osteomusculares
Libre de bacterias
Vertir su contenido a la cavidad
Abdominal peritonitis química
Netter, F.H. Atlas de Anatomía Humana. Cuarta edición. Elsevier-
Masson, 2007, 2009

8. Netter, F.H. Atlas de Anatomía Humana. Cuarta edición. Elsevier-
Masson, 2007, 2009

9. Netter, F.H. Atlas de Anatomía Humana. Cuarta edición. Elsevier-
Masson, 2007, 2009

10. Netter, F.H. Atlas de Anatomía Humana. Cuarta edición. Elsevier-
Masson, 2007, 2009

11. MECANISMOS DE LESION
CERRADO
- DESACELERACION
- DESCOMPRESION
- TORSION
- 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.

12. 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.
ANATOMOPATOLIGIA:
-ALTA
-MEDIA
-BAJA
GRADO DE AFECTACION:
I
II
III
IV

13. 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.

14. 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.

15. LABORATORIO:
- DISMINUCION DEL HEMATOCRITO
- 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.

16. Focused assessment by sonography for trauma
(FAST)
“Rozycki and colleagues reported on 1540
patients (1227 with blunt injuries, 313 with
penetrating injuries)”
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.

17. 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.

18. RX TORAX
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. TOMOGRAFIA COMPUTARIZADA
Mas comun 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.

21. Feliciano, David V.; Mattox, Kenneth L.; Moore, Ernest E. Title: Trauma, 6th Edition Copyright ©2008 McGraw-Hill
p.616

22. Feliciano, David V.; Mattox, Kenneth L.; Moore, Ernest E. Title: Trauma, 6th Edition Copyright ©2008 McGraw-Hill
p.614

23. 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.

24. 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. -ABORDAJE LAPARATOMIA
Zollinger atlas de cirugía 8Ed. Zollinger, Robert M. Mcgraw-
Hill/Interamericana, 2008, p.356

26. - DESCOMPRESION GASTRICA
-AREAS GASTRICAS DE DIFICIL ACCESO :
- UNION GASTROESOFAGICA
- FUNDUS GASTRICO
- CURVATURA MENOR
- PARED POSTERIOR
* DIFICIL IDENTIFICACION, INSUFLAR ESTOMAGO BAJO SOL SALINA
Feliciano, David V.; Mattox, Kenneth L.; Moore, Ernest E. Title: Trauma, 6th Edition Copyright ©2008 McGraw-Hill
p.675-699

27. -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.

28. - 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.

29. LESIONES EXTENSAS:
- GASTRECTOMIA PARCIAL (DISTAL – PROXIMAL) CON
GASTRODUODENOSTOMIA.
- GASTRECTOMIA DISTAL CON GASTROYEYUNOSTOMIA
- 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.