Overview
Gastric artery injury following penetrating trauma, often from gunshot, stab, or shotgun wounds, can lead to significant morbidity and mortality, including complications such as empyema, repair breakdown, and sepsis 1.Diagnosis
Clinical Presentation: Symptoms may include abdominal pain, hemodynamic instability, and signs of peritonitis.
Imaging: CT angiography or conventional angiography to identify arterial bleeding and extent of injury 1.
Endoscopy: Useful for visualizing mucosal injuries but less definitive for arterial damage 1.
Laboratory Tests: Elevated inflammatory markers and coagulation profiles may indicate severity 1.Management
Emergency Surgical Intervention: Primary repair or resection with vascular control for arterial injuries 1.
Angiographic Embolization: Considered for selective arterial bleeding to reduce blood loss and surgical complexity 1.
Blood Product Resuscitation: Aggressive transfusion protocols to manage hemorrhagic shock 1.
Infection Prevention: Prophylactic antibiotics to prevent postoperative infections, particularly empyema 1.Special Populations
Elderly: Higher risk of complications and mortality; tailored surgical approaches and intensive care monitoring recommended 1.
Comorbidities: Presence of comorbidities like shock significantly impacts morbidity and mortality; requires multidisciplinary management 1.Key Recommendations
Immediate Surgical Exploration for Penetrating Gastric Injuries: Essential for identifying and managing arterial injuries to reduce mortality (Evidence: Strong 1).
Use of Angiographic Embolization for Selective Arterial Bleeding: Can be an effective adjunct to surgical management to control bleeding (Evidence: Moderate 1).
Aggressive Hemodynamic Support and Blood Product Resuscitation: Critical in managing hemorrhagic shock associated with gastric artery injuries (Evidence: Strong 1).References
1 Durham RM, Olson S, Weigelt JA. Penetrating injuries to the stomach. Surgery, gynecology & obstetrics 1991. link