Gastric perforation following blunt abdominal trauma

Case contribution: Dr. Radhiana Hassan


  • An 11 years old boy, fall from his bicycle
  • Presented with pain at left hypochondriac region, clinically guarded abdomen
  • Vital signs are normal
  • Blood investigations are also normal
Abdominal radiograph AP supine view do not show any significant finding
CT scan abdomen and pelvis post contrast image axial plane soft tissue window

CT scan findings:

  • Multiple air pockets are seen within the peritoneal cavity (yellow arrow)
  • No obvious bowel discontinuity is seen
  • Normal bowel wall enhancement
  • No dilated bowel loops.
  • Liver, spleen, kidney and pancreas are normal

Intra-operative findings:

  • Operation showed a 2 cm perforation at body of stomach
  • The perforation site is about 2 cm from lesser curvature.
  • Small amount of contamination is seen in the peritoneal cavity.
  • Small and large bowels are normal.
  • Omental patch done.

Diagnosis: Gastric perforation from blunt abdominal trauma


  • Gastric perforation following blunt abdominal trauma is usually associated with other intra or extra abdominal injury.
  • isolated gastric perforation in blunt abdominal trauma is rare.
  • The incidence is between 0.02% to 1.7%.
  • It may occur in any location of stomach. The most common location is anterior wall (40%), greater curvature (23%), lesser curvature (15%) and posterior wall (15%).
  • Ultrasonography has poor sensitivity to detect bowel injury. however it has value in identifying free intra-abdominal fluid which is a non-specific finding.
  • Computed tomography is the imaging modality of choice.
  • Unexplained intraperitoneal fluid, pneumoperitoneum, bowel abnormalities prompt further intervention including exploratory laparotomy.
  • The surgical management of gastric injury depends on the grade of injury.

Progress of patient:

  • Discharged day 5 post op.
  • Recovered fully.
  • Review 6 months later patient was well
Author: radhianahassan