Abstract
A 57-year-old woman who had had recurrent bouts of over-eating and recumbency for depression was found to have a convulsive fit when she was suffocated due to food filled in the oral cavity after breakfast. Then she was brought into the hospital by ambulance. When she arrived at the hospital, her conscious level was III-100 (JCS) and the contents in the oral cavity had already been removed. Although she presented cyanosis, spontaneous respiration was confirmed. Moist rales were heard on the chest. The abdomen was distended but muscular defense was absent. Chest x-ray examination showed faint infiltrating shadows and large quantities of intra-abdominal free air in the bilateral lung fields. Gastrointestinal perforation associated with aspiration pneumonia was diagnosed and immediately operation was performed. Upon laparotomy an about 5-cm sized perforation running through to the lesser curvature aspect of the upper body of the stomach was identified. No organic diseases such as an ulcer and a tumor were present in the perforated site, so that spontaneous gastric perforation was diagnosed and was immediately closed by sutures.
It is etiologically considered that the abrupt increase in the inner pressure of the stomach due to vomiting and convulsion was added to the excessively expanded stomach due to repeated over-eating, causing the rupture of the stomach on the lesser curvature aspect.
