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In civilian life most abdominal injuries are due to blunt abdominal trauma. The incidence of blunt trauma is rising because of the increase in automobile accidents.1 In blunt abdominal trauma incidence of injury to the solid organs is much higher than that to the hollow viscus.
A 17 years old man presented with a history of being knocked off a bicycle by a car and landing on his left side. He complained of pain in the left upper quadrant of the abdomen. He was haemodynamically stable and abdominal examination did not reveal anything remarkable except some bruises on the left hypochondrium and lower chest at admission but later he developed signs of peritonitis. And ultrasound scan taken at admission did not reveal any abnormality. At laparotomy the only injury found was a longitudinal tear on the posterior gastric wall in the upper third of stomach. The tear was sutured and the patient made an uneventful recovery.
Injuries to the stomach are very rare in blunt abdominal trauma.1 The stomach has very strong walls and these are not torn by blunt trauma unless it is very severe or the stomach is full, or both. Such trauma commonly involves adjacent organs like the liver, spleen, and pancreas.2 Apart from injuries to the anterior gastric wall, total rupture of the gastro-oesophageal junction,3 complete circular avulsion of the stomach from the duodenum,4 and rupture of both the gastric walls5 have been reported due to blunt abdominal trauma. All of these were associated with a solid organ injury.
In our case there was an injury only to the posterior wall of stomach. There was no other intra-abdominal injury. We, after extensive literature search, believe that this is the only case of isolated posterior gastric wall injury being reported. Because of technical problems with the computed tomography equipment an ultrasound scan was performed for this patient to exclude solid organ injury in view of the clinical signs. Mallik et al suggested that a truly normal ultrasound scan in asymptomatic patients may be highly reliable for excluding significant organ injuries and these patients may be followed up without computed tomography.6 However, in retrospect, a computed tomogram with oral contrast would probably have given an idea about the injury. The most probable mechanism of injury in this patient was injury on a full stomach.