Despite preoperative duplex localization of the SPJ, SPD proved an unreliable technique in this series.

A previously well 73-year-old gentleman presented 5 days after a fall from 6 feet from a ladder with abdominal pain and vomiting. X-rays demonstrated evidence of bowel perforation. On arrival, the patient was peritonitic and displayed a severely septic picture. He was subsequently taken for emergency laparotomy. A 5 mm perforation was found in the small bowel which was repaired but unusually a large segment in the fundus and greater curvature of the stomach was found to be necrotic. A partial gastrectomy was performed and histology confirmed ischaemia likely to be secondary to trauma. The patient has now been successfully discharged home.