図４〜図６と図１３〜図１５は省略．胃が多量の食物で拡張している．図１〜図３で腹壁直下に遊離ガス（↑）と腹水（※）を認め，消化管穿孔の可能性が極めて高いが，full stomachだから胃に注目する．図９〜図１２の△は腸管外に漏出した食物残渣であり胃内容物と酷似している．図１０の▲間の胃壁は，図９と図１１の白矢印の壁と比較して見るとわかるように壁欠損像の可能性が高く，胃角部の小弯側の穿孔と診断する．A：胃前庭部，Du：十二指腸．手術で胃角部上部小弯に5cm大の穿孔を認め単純閉鎖した．

文献考察：外傷性胃穿孔，死亡率は27％．
Injury. 2001 Dec;32(10):761-4.
Blunt gastric injury. A multicentre experience.
Bruscagin V, Coimbra R, Rasslan S, Abrantes WL, Souza HP, Neto G, Dalcin RR, Drumond DA, Ribas JR.

A multicentre retrospective analysis of blunt gastric injuries from four trauma centres in Brazil was performed. From January 1982 to May 1996, 33 patients were found to have blunt gastric injury: 26 were male and the mean age was 26.2 years. The most frequent mechanism of injury was automobile versus pedestrian (17) followed by motor vehicle accidents (seven). Abdominal pain was the most common finding (29) and peritoneal signs were present in 14. There were 21 grade I, seven grade II, four grade III and one grade IV blunt gastric injuries. Simple suture was the treatment of choice in 24 patients, eight required no treatment, and only one patient underwent gastric resection. The liver and spleen were the most commonly associated injured organs. Two patients had isolated gastric injury. There were two gastric fistulae and both patients died. Overall morbidity and mortality was 12 (36%) and nine (27%), respectively. The ISS was higher in the non-survivor group (P=0.03) and the gastric organ injury score did not reach statistical significance when comparing survivors and non-survivors. We conclude that blunt gastric injury is uncommon and is associated with other injuries of greater magnitude, which generally influence mortality.PMID: 11754882