1. CAMERARUIS: St. Martn en 1822 quien recibi una herida por florete en el cuadrante superior izquierdo e hizo historia por que la herida se convirti en una fstula gstrica cutnea con la cual logr vivir hasta los 82 aos. Loria FL. Historical aspects of penetrating wounds of the abdomen. Inst Abstr Surg 87:521, 1948. 2. Mikulicz realiza la primera laparotoma exploradora en 1885 por ruptura espontnea de estmago, el desenlace fue fatal La primera operacin gstrica por arma de fuego se atribuye a Theodore Kocher. Intervencin al Presidente William McKinley quien recibe un impacto de bala, se le somete a ciruga con relacin de las heridas gstricas, pero el paciente fallece a los ocho das. Loria FL. Historical aspects of penetrating wounds of the abdomen. Inst Abstr Surg 87:521, 1948. 3. Lesion gastrica de trauma penetrante 7 a 20 % 5to lugar frecuencia Lesion gastrica de trauma cerrado 0.4 a 1.7 % (nicamente 75 casos) Astudillo R et al. Trauma, Diez aos de experiencia, Hospital Vicente Corral Moscoso. Rev. Ecuatoriande T rauma. Vol. 1 N 1. 2006 4. MORTALIDAD: TRAUMA CERRADO: 0% - 66 % ( Media 30% ) TRAUMA ABIERTO: 14% - 20% Shinkawa H, Yasuhara H, Nika S, et al: Characteristic features of bdominal organ injuries associated with gastric rupture in blunt abdominal trauma. Am J Surg 187:394397, 2004. 5. Netter, F.H. Atlas de Anatoma Humana. Cuarta edicin. Elsevier- Masson, 2007, 2009 6. Organo abdominal intratorcico Medios de fijacin laxos (4) Bien protegido por estructuras viscerales y osteomusculares Libre de bacterias Vertir su contenido a la cavidad Abdominal peritonitis qumica Netter, F.H. Atlas de Anatoma Humana. Cuarta edicin. Elsevier- Masson, 2007, 2009 7. Netter, F.H. Atlas de Anatoma Humana. Cuarta edicin. Elsevier- Masson, 2007, 2009 8. Netter, F.H. Atlas de Anatoma Humana. Cuarta edicin. Elsevier- Masson, 2007, 2009 9. Netter, F.H. Atlas de Anatoma Humana. Cuarta edicin. Elsevier- Masson, 2007, 2009 10. MECANISMOS DE LESION CERRADO - DESACELERACION - DESCOMPRESION - TORSION - CONTUSION ABIERTO Fakhry S, Watts D, Daley B, et al.: Current diagnostic approaches lack sensitivity in the diagnosis of perforating blunt small bowel injury (SBI): Findings from a large multi-institutional trial. J Trauma 51:1232, (abstract) 2001. 11. Fakhry S, Watts D, Daley B, et al.: Current diagnostic approaches lack sensitivity in the diagnosis of perforating blunt small bowel injury (SBI): Findings from a large multi-institutional trial. J Trauma 51:1232, (abstract) 2001. ANATOMOPATOLIGIA: -ALTA -MEDIA -BAJA GRADO DE AFECTACION: I II III IV 12. CLINICO: - HISTORIAL DE TRAUMATISMO SINTOMAS: - DOLOR ABDOMINAL -DIFICULTAD RESPIRATORIA - HIPO - ANOREXIA Fakhry S, Watts D, Daley B, et al.: Current diagnostic approaches lack sensitivity in the diagnosis of perforating blunt small bowel injury (SBI): Findings from a large multi-institutional trial. J Trauma 51:1232, (abstract) 2001. 13. SIGNOS: - HEMATEMESIS - CONTENIDO HEMATICO SNG - RIGIDEZ ABDOMINAL - TAQUICARDIA, HIPOTENSION - IDENTIFICACION DE LESIONES - AREA RELACIONADA - ORIFICIOS DE ENTRADA-SALIDA - OBJETOS PUNZO-CORTANTES - HEMATOMAS - LACERACIONES - EQUIMOSIS - EVISCERACION Fakhry S, Watts D, Daley B, et al.: Current diagnostic approaches lack sensitivity in the diagnosis of perforating blunt small bowel injury (SBI): Findings from a large multi-institutional trial. J Trauma 51:1232, (abstract) 2001. 14. LABORATORIO: - DISMINUCION DEL HEMATOCRITO - LEUCOCITOSIS - AMILASA - ACIDOSIS METABOLICA Fakhry S, Watts D, Daley B, et al.: Current diagnostic approaches lack sensitivity in the diagnosis of perforating blunt small bowel injury (SBI): Findings from a large multi-institutional trial. J Trauma 51:1232, (abstract) 2001. 15. Focused assessment by sonography for trauma (FAST) Rozycki and colleagues reported on 1540 patients (1227 with blunt injuries, 313 with penetrating injuries) This is not as sensitive as DPL or CT in detecting stomach or small bowel injuries, sensitivity 83.7% and specificity 99.7% for detecting hemoperitoneum. Fakhry S, Watts D, Daley B, et al.: Current diagnostic approaches lack sensitivity in the diagnosis of perforating blunt small bowel injury (SBI): Findings from a large multi-institutional trial. J Trauma 51:1232, (abstract) 2001. 16. LAVADO PERITONEAL: -SANGRE FRESCA o -RECUENTO DE HEMATIES >500/mm3 ES UN INDICADOR POSITIVO NO ESPECIFICO DE PERFORACION INTESTINAL. - AMILASA >20 IU/L SENSBILIDAD 54%, ESPECIFICIDAD 48% - FA >10 IU ESPECIFICIDAD 99.8% SENSIBILIDAD 94.7 -WBC RBC/150 SENSIBILIDAD 96.6% ESPECIFICIDAD 99.4% despues de 3 horas de la lesion Fang JF, Chen RJ, Lin BC: Cell count ratio: New criterion of diagnostic peritoneal lavage for detection of hollow organ perforation. J Trauma 45: 540, 1998. 17. RX TORAX Fakhry S, Watts D, Daley B, et al.: Current diagnostic approaches lack sensitivity in the diagnosis of perforating blunt small bowel injury (SBI): Findings from a large multi-institutional trial. J Trauma 51:1232, (abstract) 2001. 18. TOMOGRAFIA COMPUTARIZADA Mas comun en la evaluacion del abdomen en paciente hemodinamicamente estables -Traumas cerrados - Ocasionalmente en traumas abiertos Econtrando: fluido intraperitoneal, pneuoperitoneo, inflamacion de grasaperitoneal, hematomas mesentericos, extravasacion del contraste Sensibilidad 88.3% especificidad 99.4% Fakhry S, Watts D, Daley B, et al.: Current diagnostic approaches lack sensitivity in the diagnosis of perforating blunt small bowel injury (SBI): Findings from a large multi-institutional trial. J Trauma 51:1232, (abstract) 2001. 19. Feliciano, David V.; Mattox, Kenneth L.; Moore, Ernest E. Title: Trauma, 6th Edition Copyright 2008 McGraw-Hill p.616 20. Feliciano, David V.; Mattox, Kenneth L.; Moore, Ernest E. Title: Trauma, 6th Edition Copyright 2008 McGraw-Hill p.614 21. Nicholas JM, Parker Rix E, Esley KA, et al: Changing patterns in the management of penetrating abdominal trauma: the more things change, the more they stay the same. J Trauma 55:10951110, 2003. 22. Watts DD, Fakry SM: EAST Multi-Institutional Hollow Viscus Injury Research Group. Incidence of hollow viscus injury in blunt trauma: an analysis from 275,557 trauma admissions from the EAST multi-institutional trial. J Trauma 54:289294, 2003. 23. -ABORDAJE LAPARATOMIA Zollinger atlas de ciruga 8Ed. Zollinger, Robert M. Mcgraw- Hill/Interamericana, 2008, p.356 24. - DESCOMPRESION GASTRICA -AREAS GASTRICAS DE DIFICIL ACCESO : - UNION GASTROESOFAGICA - FUNDUS GASTRICO - CURVATURA MENOR - PARED POSTERIOR * DIFICIL IDENTIFICACION, INSUFLAR ESTOMAGO BAJO SOL SALINA Feliciano, David V.; Mattox, Kenneth L.; Moore, Ernest E. Title: Trauma, 6th Edition Copyright 2008 McGraw-Hill p.675-699 25. -EVACUACION DEL HEMATOMA - HEMOSTASIA - SUTURA CONTINUA 1 o 2 PLANOS -SEDA, PROLENE 3-0 o 4-0 EXTERIOR - ABSORBIBLE 3-0 o 4-0 INTERIOR Watts DD, Fakry SM: EAST Multi-Institutional Hollow Viscus Injury Research Group. Incidence of hollow viscus injury in blunt trauma: an analysis from 275,557 trauma admissions from the EAST multi-institutional trial. J Trauma 54:289294, 2003. 26. - MISMA TECNICA POR 2 PLANOS -USAR ENGRAPADORA GIA - TENER CUIDADO Y PREVENIR ESTENOSIS (GE y PILORO) Watts DD, Fakry SM: EAST Multi-Institutional Hollow Viscus Injury Research Group. Incidence of hollow viscus injury in blunt trauma: an analysis from 275,557 trauma admissions from the EAST multi-institutional trial. J Trauma 54:289294, 2003. 27. LESIONES EXTENSAS: - GASTRECTOMIA PARCIAL (DISTAL PROXIMAL) CON GASTRODUODENOSTOMIA. - GASTRECTOMIA DISTAL CON GASTROYEYUNOSTOMIA - GASTRECTOMIA PROXIMAL Y ESOFAGOGASTRECTOMIA Y PILOROPLASTIA. Watts DD, Fakry SM: EAST Multi-Institutional Hollow Viscus Injury Research Group. Incidence of hollow viscus injury in blunt trauma: an analysis from 275,557 trauma admissions from the EAST multi-institutional trial. J Trauma 54:289294, 2003.