Gastric Rupture due to blunt trauma. A case report

•Am J Med Surg – December 2025; 22 (1). 7-10 www.amjmedsurg.org DOI 10.5281/zenodo.17931977 Copyright 2025 © Unauthorized reproduction of this article is prohibited. Gastric Rupture due to blunt trauma. A case report Julio Cesar Gomez Gaytan M.D. Pamela Denisse Valdez Navarro M.D. Cesar Jair Treviño Arizmendi M.D. Gerardo Enrique Muñoz Maldonado M.D. Francisco Vazquez Fernandez M.D. Nuevo León, Mexico urrently, traumatic injuries represent one of the leading causes of mortality during the first four decades of life. Among them, blunt abdominal trauma is particularly significant, with tissue damage occurring when the summation of external forces exceeds the cohesive strength of the involved organs and tissues. In blunt abdominal trauma, the most frequently injured organs are the spleen and the liver. Gastric rupture secondary to blunt abdominal trauma is a rare clinical entity, with a reported incidence ranging from 0.02% to 1.7% in the literature. Motor vehicle collisions constitute the most common mechanism of injury, accounting for approximately 70–75% of reported cases(1). Clinically, patients typically present with abdominal distension, signs of peritoneal irritation, and hypovolemic shock. Case report A 68-year-old male was brought to the emergency department by paramedics after being struck by a motor vehicle. Upon admission, he complained of severe abdominal pain localized to the epigastrium and left upper quadrant, with physical examination revealing signs of peritoneal irritation accompanied by multiple contusions. No penetrating abdominal injuries were identified. The patient also presented with facial contusions and lacerations. On initial evaluation, vital signs were as follows: blood pressure 90/60 mmHg, heart rate 137 beats per minute, respiratory rate 21 breaths per minute, temperature 36°C, and oxygen saturation 87%. Laboratory results showed hemoglobin 12.3 g/dL, white blood cell count 23.4 ×10³/µL, platelet count 375 ×10³/µL, arterial pH 7.28, PaCO ₂ 44 mmHg, lactate 3.6 mmol/L, and bicarbonate 20.7 mmol/L. Focused Assessment with Sonography in Trauma (FAST) revealed free intraperitoneal fluid in all quadrants. Given these findings, an emergent exploratory laparotomy was performed(2). Quadrant-based surgical exploration demonstrated the presence of food-content intra-abdominal fluid and a Grade V(img.1) gastric injury involving both the anterior and posterior walls, with an approximate length of 10 cm (img.2) Primary repair of the gastric lacerations was performed using Connell–Mayo sutures with 3-0 C Background: Gastric rupture secondary to blunt abdominal trauma is a rare but life-threatening entity, with high morbidity and mortality, particularly when diagnosis and surgical management are delayed. Case presentation: We report the case of a 68-year-old male who sustained a pedestrian-versus-vehicle accident. On admission, he presented with severe epigastric and left upper quadrant pain, signs of peritoneal irritation, hemodynamic instability, and free intraperitoneal fluid on Focused Assessment with Sonography in Trauma (FAST). Emergent exploratory laparotomy revealed a Grade V gastric injury involving the anterior and posterior walls, with intact esophageal and pyloric sphincters and no other intra-abdominal organ injuries. Primary repair using Connell–Mayo sutures, gastrostomy, and feeding jejunostomy were performed, along with extensive peritoneal lavage and abdominal drainage. Despite intensive care management with vasopressor support and broad-spectrum antibiotics, the patient developed septic shock with multiple organ dysfunction and died 48 hours after surgery. Conclusion: Although rare, gastric rupture must be considered in the differential diagnosis of patients with blunt abdominal trauma and free intraperitoneal fluid, particularly in the context of recent food intake. Early recognition, timely surgical repair, adequate peritoneal lavage, and appropriate antimicrobial therapy are crucial to reduce the risk of abdominal sepsis and improve outcomes. Keywords: Gastric rupture; Blunt abdominal trauma; Case report; Emergency surgery; Multiple organ dysfunction. Intensive Care Case Report From the General surgery department at Hospital Universitario Jose Eleuterio Gonz alez. Monterrey, Mexico. Received on December 6 , 2025. Accepted on December 11, 2025. Published on December 14, 2025. Gomez Gaytan JC. et al. Am J Med Surg - December 2025; 22 (1). 7-10 www.amjmedsurg.org DOI 10.5281/zenodo.17931977 Copyright 2025 © Unauthorized reproduction of this article is prohibited. Figure 1. Gastric rupture for blunt trauma Vicryl (img.3). A gastrostomy and a feeding jejunostomy were created to ensure enteral nutritional access(4). A Blake drain was placed for postoperative abdominal drainage. Postoperatively, the patient was transferred to the intensive care unit under support with norepinephrine and vasopressin infusions. Intravenous Hartmann’s solution was administered at 100 mL/hour, with urine output measured at 0.1 mL/kg/hour. Empiric antibiotic therapy with ceftriaxone and metronidazole was initiated. Within 24 hours following surgery, the patient developed fever and marked leukocytosis (42,000/mm³), accompanied by severe hypotension refractory to vasopressor therapy. Norepinephrine dosage was escalated to 60 µg/min. In view of the clinical deterioration, the antibiotic regimen was broadened empirically to piperacillin/tazobactam, and blood cultures were obtained. At 48 hours postoperatively, the patient exhibited signs of multiple organ dysfunction syndrome, including coagulopathy, acute kidney injury, lymphopenia (120 cells/mm³), and elevated liver enzymes (AST up to 3,500 IU/L and ALT 1,688 IU/L). Despite aggressive supportive management, the patient’s clinical condition continued to worsen, culminating in cardiopulmonary arrest without return of spontaneous circulation Discussion Gastric rupture after blunt abdominal trauma is a rare but severe injury, representing a small fraction of intra-abdominal lesions in trauma patients. The reported incidence ranges from 0.02% to 1.7% and is Figure 2. Grade V gastric injury. most commonly related to high-energy mechanisms such as motor vehicle collisions, falls from height, or crush injuries. In many cases, the stomach is distended at the time of impact, and the combination of sudden deceleration, direct compression, and acute rise in intragastric pressure leads to disruption of the gastric wall, particularly along the greater curvature, anterior wall, or posterior surface. Classically, gastric rupture is associated with concomitant injuries to solid organs such as the spleen and liver, as well as to the small bowel and colon. This overlap may obscure the clinical picture and contribute to diagnostic delay. In contrast, the present case is notable for an extensive gastric laceration in the absence of other intra-abdominal organ injuries, which underscores the importance of actively considering gastric lesions even when more “typical” targets of blunt trauma (spleen, liver) appear preserved. Clinically, patients may present with abdominal pain, distension, peritoneal signs, and hemodynamic instability. However, these findings are not specific to gastric rupture and can be seen in any significant intra-abdominal injury. In hemodynamically unstable patients, bedside ultrasonography with FAST is a key diagnostic tool, allowing rapid identification of free intraperitoneal fluid and guiding the decision for emergent laparotomy in accordance with Advanced Trauma Life Support (ATLS) principles. In more stable patients, computed tomography can provide additional information regarding the location and extent of gastric lesions, the presence of pneumoperitoneum, and associated injuries. From a surgical standpoint, management is dictated by the size, location, and morphology of the Gomez Gaytan JC. et al. Am J Med Surg - December 2025; 22 (1). 7-10 www.amjmedsurg.org DOI 10.5281/zenodo.17931977 Copyright 2025 © Unauthorized reproduction of this article is prohibited. Figure 3. Primary repair of gastric injury. gastric defect, the viability of the surrounding tissue, the degree of contamination, and the presence of associated injuries. In most cases with viable margins and localized damage, primary two-layer closure is feasible and effective. When lacerations are extensive, involve devitalized segments, or compromise the gastroesophageal junction or pylorus, partial gastrectomy or more complex reconstructions—such as Billroth I or II procedures—may be necessary. In our patient, a large Grade V injury involving both the anterior and posterior walls was repaired primarily using Connell–Mayo sutures, complemented by gastrostomy and feeding jejunostomy to ensure secure enteral access in the postoperative period. Despite technically adequate surgical repair, the prognosis of gastric rupture remains guarded. Peritoneal contamination with gastric contents leads to a high risk of bacterial peritonitis, septic shock, and multiple organ dysfunction syndrome, especially when the diagnosis is delayed or when host factors are unfavorable. Advanced age, pre-existing comorbidities, profound physiologic derangement at presentation, and the magnitude of contamination are recognized negative prognostic factors. In this case, the patient was elderly, presented in shock with significant metabolic acidosis, and developed early postoperative septic shock with rapidly progressive multiorgan failure, including coagulopathy, acute kidney injury, lymphopenia, and marked elevation of hepatic transaminases. These features are consistent with a fulminant septic course, which proved refractory to aggressive resuscitation and vasopressor support. Another relevant aspect highlighted by this case is the importance of early and adequate peritoneal lavage and the timely initiation of broad-spectrum antibiotic therapy. While these measures were implemented, the severity of the initial insult and the patient’s physiological reserve likely limited the potential for recovery. This underlines the concept that, in gastric rupture after blunt trauma, even optimal management cannot always overcome the impact of the primary injury. In summary, this case reinforces several key points for clinical practice. First, gastric rupture must remain within the differential diagnosis in patients with blunt abdominal trauma, free intraperitoneal fluid, and a mechanism suggestive of increased intragastric pressure, especially in the context of recent food intake. Second, adherence to ATLS principles with rapid identification of hemodynamic instability and prompt laparotomy remains fundamental. Third, meticulous surgical technique, extensive peritoneal lavage, and early, appropriately escalated antibiotic coverage are essential components of care. Finally, close postoperative monitoring in the intensive care unit is crucial, given the high risk of septic deterioration and multiple organ dysfunction, even when definitive surgical treatment has been achieved. Conclusion Gastric injuries should always be considered within the differential diagnosis of free intraperitoneal fluid in the setting of blunt abdominal trauma (8). Management strategies vary widely depending on the patient’s hemodynamic stability and extent of injury, ranging from primary repair to complex reconstructive procedures such as Billroth techniques. Early recognition, meticulous abdominal lavage, and appropriate antimicrobial therapy are essential to reduce the risk of abdominal sepsis and improve clinical outcomes. Conflicts of interests The authors declare no conflict of interest. References 1. 1. 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