Severe upper gastrointestinal tract necrosis secondary to gastric volvulus: A case report

Abstract

Background

Gastric necrosis is a rare surgical emergency despite the stomach’s rich vascular supply. It typically results from acute gastric dilatation or volvulus. The condition occurs most frequently in patients with underlying psychiatric disorders, with a high risk of morbidity and mortality.

Case presentation

This is a 44-year-old female patient with no psychiatric history who presented with clinical signs of a high-grade obstructive syndrome, characterized by epigastric pain radiating to the back, vomiting, and associated transit disturbances. The abdominal X-ray revealed massive gastric dilatation; however, limited resources prevented the team from performing a CT scan. Resuscitation was initiated concurrently with surgical exploration, which revealed extensive necrosis of the stomach, duodenum, and jejunum. A gastrectomy, duodenectomy, and partial jejunal resection were indicated following the failure of viability tests on these organs, with a possible esophagojejunal anastomosis planned. Unfortunately, before these intraoperative procedures could be carried out, the patient died.

Clinical discussion

Large necrosis of the stomach is rarely reported with atypical clinical presentations in the existing literature; however, once necrosis has spread to the duodenum and jejunum, extensive resections are required, often with a poor prognosis.

Conclusion

Large gastric necrosis is rare but highly lethal, often presenting atypically as intestinal obstruction. Abdominal CT is essential not only for diagnosis but also for evaluating intra-abdominal damage. Emergency management ranges from simple suturing to gastrectomy, duodenectomy, or jejunectomy. Given the poor prognosis, morbidity and mortality hinge on prompt recognition and early intervention.