Abstract
A 26-year-old woman with a previous history of hyperphagia developed vomiting and abdominal pain after overeating at dinner. On the next morning she was seen at our hospital because of persisting abdominal pain. The abdomen remarkably distended but there were no peritoneal signs. Abdominal CT scan showed retention of massive food residue in the abdomen and gastric dilatation was confirmed. No intraabdominal free air and ascites were seen. A transnasal gastric tube was placed with the diagnosis of acute gastric dilatation, but no discharge from the gastric tube occurred and the patient had difficulties even in vomiting. Her condition rapidly took downhill course after a worsening of abdominal pain 14 hours after admission. Re-examination with CT showed intra-abdominal free air and ascites. Perforation of the digestive organ was diagnosed and emergency laparotomy was performed. During the surgery we confirmed about 8,800 ml of residual foods in the abdominal cavity, extensive necrosis from the fundus to the body of stomach, and a huge perforation at the posterior wall of the gastric body. The blood flow was kept intact from the cardiac part to the lesser curvature as well as at the pyloric part of the stomach. The necrotized gastric wall was resected and the anterior and posterior wall margins were closed by suture so as to form the lesser curvature side gastric tube. After the operation the patient developed multiple organ failure and intra-abdominal abscess, but finally she was discharged from our hospital on independent gait.
We present a case of acute gastric dilatation due to overeating that caused gastric necrosis and gastric perforation.
