Gastric Intramural and Portal Venous Gas Following Blunt Injury Abdomen

Abstract

Introduction: Gastric emphysema or pneumatosis is a rare finding. Early endoscopy and urgent laparotomy is advised in post-trauma patients. Case Presentation: A 29 year old man presented with blunt abdominal injury following a high-speed motorbike crash. He complained of abdominal pain and abdomen was distended. CT abdomen revealed air in the gastric wall with disruption of gastric mucosa. He had normal white cell counts, bleeding parameters and blood gases. He was treated conservatively with nasogastric decompression, intravenous analgesics and antibiotics with which he recovered well. Conclusions: Early surgical management is indicated in post-trauma patients in whom bowel infarction is suspected. In a stable patient, a negative laparotomy is a major additional stress post trauma -conservative management with close clinical observation is a suitable management alternative. Implication for health policy/practice/research/medical education: Early surgical management is advised for patients with gastric intramural air in trauma. However, a negative laparotomy causes additional stress in such patients. In a stable patient conservative management with nasogastric decompression, hemodynamic support, antibiotics and close clinical observa-tion is also a suitable line of management.