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Traumatic gastrointestinal injury in the adult patient

Author
Elizabeth Benjamin, MD, PhD
Section Editor
Eileen M Bulger, MD, FACS
Deputy Editor
Kathryn A Collins, MD, PhD, FACS

INTRODUCTION

Gastrointestinal injury of the stomach, small bowel, colon, or rectum can be due to blunt or penetrating trauma. The nature and severity of the injury depends upon the injury mechanism. Injuries range from minor bruising to complete devascularization for blunt injuries and small perforations to devascularization for penetrating injuries. Associated solid organ injury is common.

The duodenum is frequently injured in association with the pancreas and the management of these combined injuries is complex. The diagnosis and management of duodenal injuries are reviewed separately. (See "Management of duodenal and pancreatic trauma in adults".)

The diagnosis and management of gastrointestinal injury (except duodenum) due to trauma is reviewed here. The general approach to the abdominal trauma patient is discussed elsewhere. (See "Initial evaluation and management of blunt abdominal trauma in adults" and "Initial evaluation and management of abdominal stab wounds in adults" and "Initial evaluation and management of abdominal gunshot wounds in adults".)

ANATOMY

Stomach — The stomach is located in the left upper quadrant of the abdomen but can occupy other areas of the abdomen depending upon its degree of distention, phase of diaphragmatic excursion, and the positioning of the individual at the time of the injury. Anteriorly, the stomach is adjacent to the left lobe of the liver, diaphragm, colon, and anterior abdominal wall. Posteriorly, the stomach is adjacent to the pancreas, spleen, left kidney and adrenal gland, splenic artery, left diaphragm, transverse mesocolon, and colon (figure 1).

The blood supply of the stomach is from the gastric arteries. The left gastric artery, which is derived from the celiac artery, courses along the lesser curvature of the stomach and anastomoses with the right gastric artery, which is a branch of the common hepatic artery (figure 1). The right and left gastroepiploic arteries arise from the gastroduodenal artery and splenic arteries, respectively, and anastomose along the greater curvature. The short gastric arteries arise from the splenic artery and supply the fundus of the stomach.

                           

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Literature review current through: Nov 2016. | This topic last updated: Fri Oct 28 00:00:00 GMT 2016.
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