Due to the high mobility of the stomach and its protection by the rib cage, the incidence of isolated gastric injury accounts for only 1–5% of intra-abdominal organ injuries in blunt abdominal trauma. However, in penetrating abdominal injuries (especially gunshot wounds), the rate of gastric injury is higher, approximately 10–13%, ranking fourth among visceral injuries. Due to anatomical relationships, gastric injuries are often associated with other visceral injuries, particularly in penetrating abdominal trauma, with concurrent liver injuries in 34%, splenic injuries in 30%, small intestine injuries in 31%, large intestine injuries in 32%, and pancreatic injuries in 11%. The mortality rate for isolated gastric injury is 7.3%, whereas the mortality rate rises to over 40% when associated injuries are present.

bubble_chart Clinical Manifestations

The clinical manifestations of gastric injury depend on the extent and severity of the injury, as well as the presence of other organ injuries. Partial injury to the gastric wall may not cause obvious symptoms. Full-thickness rupture of the gastric wall allows highly chemically irritating gastric contents to enter the abdominal cavity, leading to severe abdominal pain and peritoneal irritation signs. This may include vomiting bloody material, disappearance of liver dullness, and the presence of free gas under the diaphragm.

bubble_chart Diagnosis

Posterior gastric wall or incomplete gastric wall rupture may present with atypical symptoms and signs, making early diagnosis difficult. A gastric tube can be inserted for suction to check for blood in the stomach. Additionally, injecting an appropriate amount of gas or water-soluble contrast agent for imaging can aid in diagnosis.

bubble_chart Treatment Measures

Once diagnosed, surgery should be performed promptly. During the operation, attention should be paid to whether there are combined injuries to other organs to prevent missed diagnosis of {|###|}fistula disease{|###|} and avoid delaying treatment. Injuries to the anterior wall of the stomach are easily detected, but incomplete injuries to the posterior wall, fundus, and cardia may be missed as {|###|}fistula disease{|###|}, so exploration must be thorough. In one-third of cases, perforations occur in both the anterior and posterior walls of the stomach. The gastrocolic ligament should be incised to expose the posterior wall, with special attention paid to the attachments of the greater and lesser omenta to prevent missing small perforations of {|###|}fistula disease{|###|}. Although injecting air or methylene blue solution through a gastric tube can aid in intraoperative localization, it risks worsening peritoneal contamination and should be used cautiously.

If the injury involves only the mucosal layer and is confirmed preoperatively, with minimal bleeding and no combined injuries to other organs, non-surgical treatment may be considered. However, if hemorrhagic shock occurs, surgical intervention is preferable. Even a simple gastric mucosal laceration can result in blood loss of up to 2L, requiring surgical incision of the gastric wall to directly locate and ligate the bleeding site, with additional measures such as sodium morrhuate or gelatin sponge compression for hemostasis, followed by suturing the torn mucosa.

Gastric wall hematomas may be associated with "transmural perforation." The serosal layer at the edge of the hematoma should be incised to evacuate the hematoma and achieve hemostasis. Depending on the depth of the gastric wall injury, full-thickness or seromuscular layer sutures should be used for repair.

Clean lacerations can be directly sutured after hemostasis. If the edge tissue is contused or nonviable, it should be debrided before suturing. Gastrectomy is generally not required unless the gastric wall is extensively or severely damaged.

Other combined injuries should be managed according to their specific conditions.

Before closing the abdomen, thoroughly aspirate gastric contents from the peritoneal cavity and irrigate with copious saline. Simple gastric injuries do not require drainage.

Postoperatively, continue antibiotic therapy and maintain nutrition, fluid, and electrolyte balance.