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BMJ Case Reports 2017; doi:10.1136/bcr-2016-218513
  • Rare disease
  • CASE REPORT

Acute massive gastric dilatation causing ischaemic necrosis and perforation of the stomach

  1. Gareth Morris-Stiff1
  1. 1Section of HPB Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA
  2. 2Department of General Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA
  1. Correspondence to Dr Gareth Morris-Stiff, garethmorrisstiff{at}hotmail.com
  • Accepted 1 May 2017
  • Published 15 June 2017

Summary

Acute massive gastric dilatation (AMGD) is a rare distinctive condition but associates with high morbidity and mortality. Though usually seen in patients with eating disorders, many aetiologies of AMGD have been described. The distension has been reported to cause gastric necrosis with or without perforation, usually within 1–2 days of an inciting event of AMGD.

We report the case of a 58-year-old male who presented with gastric perforation associated with AMGD 11 days after surgical relief of a proximal small bowel obstruction. The AMGD arose from a closed loop obstruction between a tumour at the gastro-oesophageal junction and a small bowel obstruction as a result of volvulus around a jejunal feeding tube.

To our knowledge, this is the first case of a closed loop obstruction of this aetiology reported in the literature, and the presentation of this patient’s AMGD was notable for the delayed onset of gastric necrosis. The patient underwent an exploratory laparotomy and a partial gastrectomy to excise a portion of his perforated stomach. Surgeons should be aware of the possibility of delayed ischaemic gastric perforation in cases of AMGD.

Footnotes

  • Contributors MAM wrote, revised the paper and was involved in the planning, conduct, reporting, conception and design, acquisition of data and analysis and interpretation of data. JM participated in the planning, conduct, reporting, conception and design, acquisition of data and analysis and interpretation of data. GF participated in the planning, conduct, reporting, conception and design, acquisition of data and analysis and interpretation of data. JSU supervised the paper and provided feedback and direct revisions. GM-S is the senior author of the paper and he supervised and revised all the above.

  • Competing interests None declared.

  • Patient consent Obtained from next of kin.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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