Traumatic rupture of gastric pull-up after apparent mild thoracic trauma: a case report and literature review

While elderly patients account for only 10–12% of all trauma victims, they consume 25% of trauma-related health care resources, with higher rates of mortality and complication. Presently described is the case of an elderly patient who presented to the emergency department (ED) following mild thoracic trauma, with previous history of gastric pull-up surgery. The patient had consulted another facility 48 hours earlier and was prescribed analgesia and x-ray follow-up for a mechanical fall and pain in the lower rib cage. At arrival, the patient complained of increasing dyspnea and pain at the right hemithorax. X-ray showed right hemithorax effusion, and contrast computed tomography (CT) demonstrated a large amount of contrast filling the pleural space and a relatively small point of gastric pull-up rupture in the stomach. The patient was referred to the cardiothoracic unit, but was unresponsive upon arrival and died. The aim of the present report was to raise the index of clinical suspicion of traumatic rupture of the gastric pull-up following traumatic chest injury, and to affirm that contrast CT should be the gold standard for diagnosis.

Belirgin bir toraks travmasý ardýndan gastrik pull-up’ýn travmatik rüptürü: Bir olgu raporu ve literatürün gözden geçirilmesi

Yaþlý hastalar tüm travmaya uðrayanlarýn yalnýzca %10–12’sini oluþturmasýna raðmen göreceli yüksek mortalite ve komplikasyon oranlarýyla saðlýk kaynaklarýnýn %25’ini tüketmektedirler. Bu yazýda, daha önce gastrik pull-up cerrahisi geçirmiþ, hafif bir göðüs travmasý ardýndan acil servise (AS) baþvuran yaþlý bir hasta sunuldu. Hasta 48 saat önce baþka bir merkeze baþvurmuþ, düþme ve göðüs kafesi alt kýsmýndaki aðrýsý için aðrý kesici reçetelendirilmiþ ve radyolojik takip önerilmiþ. Hasta acil servise vardýðýnda giderek artan nefes darlýðý ve sað hemitoraksta aðrýdan yakýnmýþtýr. Röntgende sað hemitoraksta efüzyon, kontrastlý bilgisayarlý tomografide (BT) plevra boþluðunu dolduran büyük miktarda kontrast madde ve midede gastrik pull-up operasyon yerinde oldukça ufak bir rüptür görülmüþtür. Hasta kardiyotorasik birime sevk edilmiþ olmasýna raðmen vardýðýnda bilinç kaybý vardý ve yaþamýný yitirmiþti. Bu olgu sunumunun amacý, toraks travmasýndan sonra gastrik pull-up yerinde travmatik rüptürden yüksek derecede klinik kuþku duyulmasýný saðlamak ve tanýda altýn standardýn mutlaka kontrastlý BT olduðunu doðrulamaktý.