Massive gastric bleeding from a blunt abdominal trauma: report of a case.

Blunt gastric injury (BGI) is a rare condition that accounts for 0.02%-1.7% of all blunt abdominal trauma cases. Blunt gastric rupture, which occurs in less than 40% of all BGI cases, presents unstable vital signs and symptoms of peritonitis due to massive peritoneal contamination. This article presents the case of a patient with BGI who did not present with symptoms of peritonitis in spite of presenting with persistent hypovolemic shock.

Jejunal loop obstruction by a gallstone from hepaticojejunostomy-induced acute cholangitis: report of a case.

We report a case of jejunal loop obstruction by a large gallstone caused by Roux-en-Y hepaticojejunostomy-induced acute cholangitis. The patient was admitted with sepsis as well as abdominal and back pain. Abdominal computed tomography showed a dilated jejunal loop and an obstructing large mass. After his clinical condition and laboratory values improved, we performed laparotomy, which revealed a dilated jejunal loop with a palpable mass, and a gallstone was removed via enterotomy. After the disimpaction of the stone and control of the infection, his clinical condition and laboratory values continued to improve. Gallstone formation is rare after hepaticojejunostomy and to our knowledge, no other cases of acute cholangitis caused by a stone obstructing the jejunal loop have ever been reported. As with other major complications, early diagnosis and prompt initiation of surgical treatment are important to prevent any deterioration in the patient's general condition.

Diagnostic peritoneal lavage for diagnosing blunt hollow visceral injury: the accuracy of two different criteria and their combination.

PURPOSE: To test the usefulness of diagnostic peritoneal lavage (DPL) for identifying blunt hollow visceral injury with two different sets of criteria or a combination of the two. METHODS: Fifty victims with physical examinations and/or computed tomography findings equivocal for blunt hollow visceral injury underwent DPL. Whether or not to perform surgery was determined based on Otomo's DPL criteria [lavage white blood cell counts (L-WBC) over lavage red blood cell counts (L-RBC) divided by 150 (L-WBC > or = L-RBC/150) in the presence of hemoperitoneum, or L-WBC over 500/mm(3) (L-WBC > or = 500) in the absence of hemoperitoneum]. The cell count ratio, a comparison of L-WBC, L-RBC, peripheral WBC (P-WBC), and peripheral RBC (P-RBC) [(L-WBC/L-RBC)/(P-WBC/P-RBC) > or = 1] were all calculated retrospectively. RESULTS: There were one and two false-positive cases based on Otomo's criteria and the cell count ratio, respectively, with corresponding accuracies of 97.8% and 95.7%, respectively. There were no false-positive or -negative cases according to the combined use of Otomo's criteria and cell count ratio, yielding an accuracy of 100%. CONCLUSION: Although each criterion alone is very accurate in predicting the presence of blunt hollow visceral injury, the combined use of the two would further improve the accuracy of the diagnosis and thereby reduce the number of unnecessary celiotomies.