Gastric Perforation Due to Ischemic Necrosis: Radiological Diagnosis and Emergency Surgical Management. Case Report

Abstract

Gastric necrosis is an extremely rare clinical entity due to the stomach’s rich vascularization, which usually protects it from ischemia (1,2). When it presents as acute gastric perforation, it constitutes a devastating surgical emergency with high mortality, often exceeding 50–60% even with early surgical management, and reaching up to 80% in patients presenting with septic shock (2,3). We report the case of a 53-year-old male patient with multiple comorbidities and previous surgical history, who presented with acute abdominal pain, leukocytosis, and radiological findings suggestive of hollow viscus perforation. Computed tomography revealed abundant pneumoperitoneum and free fluid, which led to emergency exploratory laparotomy. Intraoperatively, transmural ischemic necrosis with perforation of the anterior wall of the stomach from the fundus to the antrum was identified, without evidence of other ischemic lesions (6,16). Segmental gastric resection and primary closure were performed; however, the patient died in the early postoperative period. This case underscores the importance of early clinical suspicion, prompt radiological diagnosis, and immediate surgical intervention (2,13). Despite progress in diagnostic and therapeutic techniques, perforated gastric necrosis remains a condition with extremely high lethality, often requiring damage control surgical strategies in patients with hemodynamic instability (16).