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Once the stomach is decompressed and repositioned, the gastric wall should be evaluated for evidence of necrosis. The greater curvature, at the junction between the fundus and the body, is the most common site for necrosis. The serosa is often bruised and, following repositioning, it should be monitored for 5–10 minutes prior to full assessment. Subjective assessment of tissue viability is the most practical and useful method. The gross appearance of the stomach wall is a useful indicator. If the wall is discolored (gray, green, purple or black), has areas of seromuscular tearing or is much thinner on palpation, ischemia is present and subsequent necrosis is likely (Figure 8.8). Gastric vessels should be gently palpated for evidence of pulses or thrombi. If a more objective assessment is required, a partial thickness (seromuscular) incision can be made to assess perfusion. Active bleeding implies that the tissue is viable whereas a lack of bleeding suggests that resection is necessary. More objective methods for assessment of gastric wall viability include fluorescein dye, scintigraphy and laser Doppler flowmetry [47–49]. These techniques, however, are not widely available and may be impractical in the clinical setting.