A Case of Severe Blunt Gastrointestinal Injury Successfully Treated Surgically with Damage Control Surgery

Abstract

Recently, damage control surgery has found a wide application in a variety of situations. We report herein on a case of unrepairable traumatic gastrointestinal tract injury for which we applied damage control surgery. An 84-year-old man was transferred to our hospital with injuries sustained in a car crash. He had a previous medical history of surgical procedures including gastrectomy and hepatectomy. On arrival, the patient was in shock, and an abdominal enhanced computed tomography scan demonstrated intraperitoneal free air at the epigastric region. An emergency laparotomy was performed. On laparotomy, the Billroth-Ⅱ fashioned gastro-jejunal anastomosis was ruptured. Because of hemodynamic instability and unrepairable injury, we undertook damage control surgery without primary reconstruction. The ruptured anastomosis was transected and the distal stump of the remnant stomach was closed by suturing. The stump of the jejunum was constructed into external fistulas. After the operation, the patient slowly recovered under strict management of nutrition. After improvement of his condition, we performed a second-look operation for reconstruction of the gastrointestinal tract. In conclusion, damage control surgery is a feasible and successful approach for the management of at-risk and unstable patients.