Gastric injuries are common in penetrating trauma to the abdomen and lower chest, but in blunt trauma, they are rare and account for a small minority of hollow viscus injuries. Although gastric injuries caused by penetrating trauma are not life threatening during the so-called golden hour, associated thoracic and vascular injuries can compromise the hemodynamic status of the patient. Therefore, initial management of the patient should follow the priority principles established by ATLS. Like injuries to other hollow viscera, gastric injuries caused by blunt abdominal trauma can manifest late, making the diagnosis more difficult and the prognosis worse. The mechanism of injury, physical exam, and diagnostic imaging can suggest gastric injuries; however, the gold standard remains exploratory laparotomy.