Teaching Case

38-years-old male car driver involved in a traffic accident presented with severe abdominal pain.

38-years-old male car driver involved in a traffic accident presented with severe abdominal pain. Ultrasound showed a large amount of free intraabdominal fluid. CT was performed (MD-CT, 4x2.5 mm/12.5 mm, Siemens VolumeZoom). A lagre amount of free abdominal fluid was detected corresponding to the ultrasound findings. Furthermore, free intraabdoninal gas was present indicating that a gastrointestinal perforation must have taken place. The stomach was well filled. A lagre tear in the anterior gastric wall was found (Figure 1c-d). No other abdominal injury was detected.

Gastric rupture from blunt abdominal trauma is rare. The most common cause is motor vehicle accidents (1-4). Mostly the rupture is due to a well filled stomage at the time of trauma (present case). The most frequent rupture site is the anterior wall of the stomach (present case). Other possible mechanisms are compression of the stomach against the vertebral column and sheering stress due to deceleration(1). Complete traumatic gastric transection may occour and may be complicated by traumatic vagotomy with consecutive pyloric dysfunction and gastric stasis(3). Even without primary gastric rupture injury of supplying arteries may lead to secondary gastric necrosis and perforation (4). The present case shows a rare case of gastric rupture in typical location (anterior wall) due to blunt abdominal trauma. Surgery was performed. No other abdominal injury was detected at surgical exploration. The postoperative course was uneventful. The patient was questioned afterwards and reported an oppulent meal before he got involved in the car wreck.