66.8 Stomach injuries

The stomach can be penetrated by a missile or by a stab wound. It is very vascular, and its mucosa readily bleeds, so suture it with a continuous suture which compresses the whole length of its mucosal edge.

Figure 66.14: SUTURING A STOMACH WOUND. A, and B, show the method of suturing. C, shows the wound in the anterior wall of the stomach, and D, the wound in its posterior wall. The edges of wound are being held in stay sutures, ready for repair. With the kind permission of Peter London.

STOMACH INJURIES

Examine both surfaces of the patient’s stomach by opening his lessen sac through his gastrocolic omentum as in C, Fig. 66-14, and turning his stomach upwards so that you can inspect its posterior wall.

First trim the hole, to make sure you are suturing viable mucosa with clean cut edges.

Use 2/0 chromic catgut to close the wound in two layers. Make the first layer an all coats, continuous inventing suture. Make the second layer of continuous Lembert seromuscular sutures (9.3). Close the wound as if you were closing the small gut, except that there is no need for the closure to be transverse to the stomach.

Alternatively, insert a catgut stitch at one end of the hole, and tie it. Now put a running stitch in and out of the stomach all round the hole, closing it as you do so. Put your thumb into the hole to invent the mucosa as you pull up the stitches (this kind of suture does not invert automatically). If possible, try to get all the mucosa inside the stomach. When you have tied the knot, you have closed the hole. Hide the all coats layer of sutures with an extra layer of Lembent sutures (9.3).