Internally Peer Reviewed Preferential redistribution of blood flow in the shock state results in splanchnic ischemia. The ischemic mucosal insult can subsequently result in gastric stress ulceration, especially in the presence of associated sepsis. Gastrointestinal hemorrhage of significant degree is usually the presenting symptom. The onset of bleeding usually presents about ten days post injury. These gastric ulcerations are frequently multiple.
Perforation can occur.
Prophylactic therapy consists of antacid buffering of the gastric content, and administration of a histamine hydrogen receptor antagonist, such as cimetidine. Enteral alimentation is also thought to provide gastric mucosal protection and should be instituted when feasible. Intractable upper gastrointestinal hemorrhage from stress ulceration may require gastric resection or vagotomy and pyloroplasty. Perforation is another indication for operative intervention. Acalculous cholecystitis may occur in trauma victims at a time when it is most difficult to diagnose.