Rationale: Gastroscopymay not only allow identification of gastric injury, but may also facilitate prompt repair. Patient concerns: A 39-year-old male patient was admitted 3hours after abdominal injury caused by penetration of a screwdriver. Physical examination and computed tomography showed no evidence of gastric injury. However, 3000mL fresh blood was vomited during the subsequent observation period. Diagnoses: Gastroscopy identified a ruptured artery and gastric perforation. Interventions: Repaired immediately using titanium clips. Outcomes: After operation, the patient recovered well without complications. No more bleeding was observed after the operation. Lesson subsections asper style: Interventional endoscopy has evolved as an effective alternative to primary surgery for treating gastrointestinal perforation.