Gastric Rupture due to blunt trauma. A case report

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.