Gastric injury is relatively uncommon in closed abdominal injuries, accounting for approximately 3.16% of abdominal injuries and typically occurring only occasionally in cases of a full stomach. Penetrating injuries to the upper abdomen or lower chest often involve the stomach and are frequently accompanied by injuries to the liver, spleen, diaphragm, and pancreas. Gastric endoscopy and the ingestion of sharp foreign objects can also lead to perforation, though this is rare. If the injury does not involve the entire gastric wall (e.g., serosal or seromuscular tears, mucosal tears), there may be no significant symptoms. However, in cases of full-thickness rupture, the patient will immediately experience severe abdominal pain and signs of peritoneal irritation, disappearance of the liver dullness border, free gas under the diaphragm, and bleeding from gastric tube drainage. Isolated rupture of the posterior wall of the stomach may present with atypical symptoms and signs, sometimes making diagnosis challenging.
Management
In cases of small gastric injuries occurring when the stomach is empty, with minimal contamination of the peritoneal cavity and no significant signs of peritonitis, non-surgical management such as fasting and gastric decompression can be considered, while closely monitoring the patient's condition. For more severe injuries, immediate surgical exploration is required, including incising the gastrocolic ligament to examine the posterior wall of the stomach. Special attention should be paid to the attachments of the greater and lesser omentum to avoid missing small perforations. In penetrating injuries, both the anterior and posterior walls of the stomach should be explored. In cases of extensive damage, partial gastrectomy may be performed; however, total gastrectomy is rare.