Gastric barotrauma following submarine escape training

Seventeen case reports of gastric barotrauma following diving have been published previously. We report the case of a 32-year-old healthy male suffering gastric barotrauma in 1987. The incident happened during a military submarine exercise. The patient escaped the submarine at 150 metres water depth but was entangled for a short time in the escape tower and, likely distressed and in a state of panic, swallowed significant amounts of air. He experienced abdominal pain during ascent. Given the special circumstances of this event, medical personnel primarily expected symptoms to be caused by decompression sickness and initiated therapeutic recompression on site. No improvement occurred during recompression, and he was admitted to hospital. Abdominal X-ray disclosed free abdominal gas which was exsufflated in the emergency room. Emergency abdominal surgery revealed a 9 cm rupture of the lesser gastric curvature which was sutured. Recovery was uneventful. We discuss the proper approach to divers experiencing abdominal pain following ascent.