Intraluminal Stomach Injury after Blunt Trauma

Abstract

A 51-year-old male was admitted to the emergency room after a traffic accident. He was a carrier of hepatitis B and had liver cirrhosis of Child Pugh classification A. Upon arrival, he was stupor with multiple laceration of the scalp and face and a belt sign on the abdomen. Physical examination revealed no peritoneal irritation signs or abdominal distension. Initial computed tomography (CT) of the abdomen revealed no definite intraabdominal organ injury, except for stomach distension with the presence of intraluminal fluid (Fig. 1.). He underwent an emergency craniotomy for traumatic epidural hematoma with stable hemodynamics. His injury severity score was 38. During intensive care, massive hematochezia was presented with hypotension, and a hemoglobin level of 6.7 g/dL was observed at 11 h after the operation. In addition, esophagogastroduodenal endoscopy revealed multiple mucosal lacerations on cardia, with active bleeding and no varices (Fig. 2.). Because his hemodynamics were stabilized with response to massive transfusion (red blood cell, 16 units; fresh frozen plasma, 13 units; platelet, 16 units), he was conservatively treated with a proton pump inhibitor, antithrombin III, and tranexamic acid, and finally progressed to full recovery.