図１〜図３で遊離ガス（↑）があり，図４〜図９のMorison窩の※と，図９の胃背側の△は腹水である．図５〜図８の▲間の胃壁は欠損（wall discontinuity）を示しており，胃角部から後壁に進展する胃穿孔と診断する．手術で腹腔内と網嚢内に多量の血性腹水があり，胃角部から後壁に広がる約3cm大の胃穿孔を認め，単純閉鎖した．

文献考察：外傷性胃穿孔，5例（全腹部外傷の1％），全5例にfull stomachを認めた．死亡率は14％
Am J Surg. 2004 Mar;187(3):394-7.
Characteristic features of abdominal organ injuries associated with gastric rupture in blunt abdominal trauma.
Shinkawa H, Yasuhara H, Naka S, Morikane K, Furuya Y, Niwa H, Kikuchi T.

BACKGROUND: Previous studies have investigated the mechanisms of gastric rupture based only on the findings in gastric rupture and excluding gastric lacerations. METHODS: We investigated 14 cases of gastric injury (five with rupture and nine with laceration) from blunt abdominal trauma with or without thoracic trauma. Gastric injuries were caused by a traffic accident in 12 and by a fall in two patients. All of the patients with gastric rupture had had a full stomach at the time of impact. RESULTS: The patients had associated injuries of adjacent solid organs, the thoracic cage, and extremities. The frequency of injury of the hepatoduodenal or gastrohepatic ligament was higher in patients with gastric laceration than in patients with gastric rupture. Eight of nine patients with a gastric laceration had hepatic or pancreatic injury, whereas none of the patients with gastric rupture had such injury. CONCLUSIONS: The results of our study showed that the distended stomach tends to rupture by absorbing the impact from blunt abdominal trauma (i.e., it works like an airbag to protecting adjacent organs such as the liver and pancreas).PMID: 15006569