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CASE REPORT
Year : 2017  |  Volume : 20  |  Issue : 5  |  Page : 645-646

Total gastric necrosis: A case report and literature review


1 Department of General Surgery, Wuyi First people's Hospital, Wuyi, China
2 Department of General Surgery, The Second Affiliated hospital, College of Medine, Zhejiang University, Hangzhou, China

Date of Acceptance04-Jan-2017
Date of Web Publication17-May-2017

Correspondence Address:
Y Jin
Department of General Surgery, The Second Affiliated Hospital, College of Medine, Zhejiang University, Hangzhou
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1119-3077.206364

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   Abstract 

Total gastric necrosis is a rare disease and easy to misdiagnose. Here we report a rare case of total gastric necrosis. The patient, an 89-year-old male, had epigastric pain for 5 days. He was transferred to our hospital because of intraperitoneal hemorrhage and hypovolemic shock. We performed an emergency laparotomy. During the surgery, we found a total of 3500ml unclotted blood in the abdomen, splenic infarction and gastric necrosis. Total gastrectomy with Roux-en-Y esophagojejunostromy and splenectomy was performed. However, the patient died on the second day after the surgery. This case suggests that surgical treatment should be performed as early as possible when ischemia of abdominal organs is suspected.

Keywords: Gastric vascular thrombosis, Roux-en-Y esophagojejunostromy, total gastric necrosi
Key Messages: Total gastric necrosis is a rare disease with no specific clinical manifestation. When it is suspected, surgical treatment should be carried out immediately.


How to cite this article:
Huang G, Jin Y. Total gastric necrosis: A case report and literature review. Niger J Clin Pract 2017;20:645-6

How to cite this URL:
Huang G, Jin Y. Total gastric necrosis: A case report and literature review. Niger J Clin Pract [serial online] 2017 [cited 2020 Feb 22];20:645-6. Available from: http://www.njcponline.com/text.asp?2017/20/5/645/206364


   Introduction Top


Total gastric necrosis is a rare condition with only few cases being reported. The causes in the reported cases are varied, including gastric dilatation, inflammation, toxicosis, vascular thrombosis/embolism and others [1],[2],[3]. There is no specific clinical manifestation of gastric necrosis. Enhanced CT indicates vascular thrombosis or gastric dilatation. When total gastric necrosis is suspected, surgical treatment should be carried out immediately. Here we report a case of intraperitoneal hemorrhage caused by gastric necrosis.


   Case History Top


An 89-year-old male was admitted to a local hospital because of epigastric pain. Five days later, the patient was transferred to our hospital because of intraperitoneal hemorrhage and hypovolemic shock. He had an 8-year history of hypertension and 12-year history of atrial fibrillation with nifedipine and aspirin. Physical examination showed low blood pressure (93/55mmHg), fast heart rate (123 beats/min) with atrial fibrillation, and suspicious abdominal tenderness with positive shifting dullness. B-ultrasonography of the abdomen showed peritoneal ascites, and diagnostic abdominal paracentesis revealed non-clotting blood. 50ml pale bloody fluid was drained from the gastric tube.

After blood transfusion and fluid infusion, emergency laparotomy was performed. A total of 3500 ml unclotted blood was found in the abdominal cavity. The stomach was unexpanded, but the wall was dark purple with no peristalsis [Figure 1]. There was thrombosis of left gastric artery, gastroepiploic artery and splenic artery. The small intestine and the colon were normal.
Figure 1: Total gastric necrosis. A: spleen enlargement (Black arrow) and ischemic infarction, total gastric necrosis (White arrow). B: The stomach wall was dark purple and total gastric necrosis.

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Total gastrectomy, Roux-en-Y esophagojejunostromy and splenectomy were performed smoothly. Post-operative pathological examination revealed gastric intravascular thrombosis and total gastric wall avascular necrosis. However, due to the difficulty in preventing disseminated intravascular coagulation (DIC) and repeated appearance of postoperative ventricular fibrillation (VF), the patient died two days after the surgery in the intensive care unit.


   Discussion Top


Total gastric necrosis is rare as the stomach blood supply is normally sufficient. Partial vascular abnormalities or embolization generally do not cause ischemia and necrosis. The causes of gastric necrosis in the reported cases are varied, including gastric dilatation, inflammation, toxicosis, vascular thrombosis/embolism and others [1],[2],[3],[4],[5],[6],[7],[8],[9] [Table 1]. Our patient is another case of vascular thrombosis of the stomach with a fatal outcome.
Table 1: Literature review on total gastric necrosis

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Vomiting, nausea and abdominal pain were the main clinical manifestations in this case, but they are not specific. Most of the patients having gastric necrosis are misdiagnosed with intestinal obstruction. In our report, the patient was treated for intestinal obstruction with conservative treatment for five days in a local hospital. Then, he was transferred to our hospital because of intraperitoneal hemorrhage and hypovolemic shock. As a result of our national conditions, there is huge variation in diagnosis and treatment level across hospitals.[10] It is crucial therefore to transfer patients to a medical center, which is capable of offering proper treatment.

The main reasons of death for our patient were DIC and VF. The patient had a long history of atrial fibrillation, which increased the probability of abdominal vascular thrombosis and led to organ ischemia and necrosis. DIC happened when the patient arrived to our hospital and eventually led to his death a day after the surgery. In our opinion, once total gastric necrosis is suspected, surgical treatment should be carried out immediately.

Acknowledgement

Nil

Financial support and sponsorship

Nil

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Rieger A, Bachmann J, Schulte-Frohlinde E, Burzin M, Nahrig J, Friess H, et al. Total gastric necrosis subsequent to acute pancreatitis. Pancreas 2012;41:325-7.  Back to cited text no. 1
    
2.
Patocskai EJ, Thomas JM. Gastric necrosis in a patient with bulimia. Eur J Surg 2002;168:302-4.  Back to cited text no. 2
    
3.
Davis LL, Raffensperger J, Novak GM. Necrosis of the stomach secondary to ingestion of corrosive agents: Report of three cases requiring total gastrectomy. Chest 1972;62:48-51.  Back to cited text no. 3
    
4.
Bais JE, Samsom M, Boudesteijn EA, van Rijk PP. Akkermans LM, Gooszen HG, Impact of delayed gastric emptying on the outcome of antireflux surgery. Ann Surg 2001;234:139-46.  Back to cited text no. 4
    
5.
Lee D, Sung K, Lee JH. Acute gastric necrosis due to gastric outlet obstruction accompanied with gastric cancer and trichophytobezoar. J Gastric Cancer 2011;11:185-8.  Back to cited text no. 5
    
6.
Powell JL, Payne J, Meyer CL, Moncla PR. Gastric necrosis associated with acute gastric dilatation and small bowel obstruction. Gynecol Oncol 2003;90:200-3.  Back to cited text no. 6
    
7.
Dharap SB, Ghag G, Biswas A. Acute necrotizing gastritis. Indian J Gastroenterol 2003;22:150-1.  Back to cited text no. 7
[PUBMED]  [Full text]  
8.
Bortul M, Scaramucci M, Tonello C, Spivach A, Liguori G. Gastric wall necrosis from organo-axial volvulus as a late complication of laparoscopic gastric banding. Obes Surg 2004;14:285-7.  Back to cited text no. 8
    
9.
Challand C, Titcomb D, Armstrong CP. Pancreatic pseudocyst causing celiac artery trunk thrombosis. JOP 2008;9:512-4.  Back to cited text no. 9
    
10.
Han J, Wu MC, Yang T. Challenge of China's rural health. BMJ 2016;353:i2003.  Back to cited text no. 10
    


    Figures

  [Figure 1]
 
 
    Tables

  [Table 1]


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