Rupture of the stomach complicating diving accidents.

All reported cases of rupture of the stomach after a diving accident were reviewed for this study. This is a rare event that complicates brief and deep dives. It is always the consequence of equipment failure or panic reactions which induce swallowing air while under water. During a rapid ascent, the gas expands causing rupture. Diagnosis is based on the presence of abdominal distention associated with pneumoperitoneum on the x-ray and with gastric tears seen on gastroscopy. Pneumoperitoneum from gastric rupture must be distinguished from that caused by pulmonary barotrauma. Peritoneal decompression by paracentesis may quickly improve the patient's condition. After air embolism or decompression sickness has been ruled out, a surgical operation is necessary. Exploratory laparotomy exposes, in two thirds of cases, a gastric full-thickness tear that requires closing by suture. The outcome is good because subjects are young and healthy. The rupture of a filled stomach may lead to postoperative complications (abscess or fistulas).