D. G. Davila1, A. Goldin1, B. Appel1, N. Kugler1, T. Neideen1 1Medical College Of Wisconsin,Trauma/Critical Care,Milwaukee, WI, USA
Introduction:
Penetrating gastric injuries comprise a small portion of traumatic injuries. A paucity of data exists regarding current management, including acid suppression and nasogastric (NG) decompression.
Methods:
A single-institution retrospective of adult patients with penetrating gastric injuries between January 2004 and December 2014 was conducted. The primary study endpoint was 30-day mortality. Secondary endpoints included organ-space infections. Patients with >48 hours of proton pump inhibitor or H2 blocker were considered managed by acid suppression; >48 hours of NG management was considered decompressed.
Results:
A total of 167 patients were identified with the majority (77.2%) the result of a gunshot injury. The cohort was predominantly (90%) male at an average age of 30.4 years and ISS score of 16.5. Twenty-one patients died within 24-hours with four additional in-hospital deaths. The liver was the most common (42%) associated injury, followed by the diaphragm and the colon. Forty-five patients had two or more operations prior to closure. A single missed gastric injury was identified on second-look. There were no instances of gastric repair breakdown with no difference in complication rates between one or two layer repair (p=0.73). Organ-space infections were identified in 31 (21%) patients, most likely the result of an alternative source. Neither acid suppression nor NG tube was significantly associated with death (p=0.29 and p=0.64, respectively) or organ-space infection (p=0.89and p=0.11, respectively).
Conclusion:
Neither acid suppression nor NG tube decompression appear to protect against death nor the infectious morbidity associated with penetrating gastric injuries.