Gastric Necrosis Caused by Acute Gastric Dilatation after an Episode of Bulimia

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  • Kojima Hirofumi
    Department of Surgery, Yokohama City Minato Red Cross Hospital
  • Obi Yoshihiro
    Department of Surgery, Yokohama City Minato Red Cross Hospital
  • Abe Tetsuo
    Department of Surgery, Yokohama City Minato Red Cross Hospital

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  • 過食後の急性胃拡張による胃壊死の1例

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A 33-year-old man who had developed schizophrenia while in jail was transported to our hospital by ambulance due to consciousness disturbance associated with an episode of bulimia. Although he had no abdominal pain or distention, a plain X-ray of the abdomen showed marked dilatation of the stomach. On day 7 of hospitalization, the patient suffered hematemesis, fall in blood pressure, and abdominal pain. Physical examination revealed significant abdominal distention, with signs of peritoneal irritation. Abdominal CT revealed bubbles within the gastric wall, and gas within the portal vein of the liver. We suspected gastric necrosis caused by acute gastric dilatation, and an emergency laparotomy was performed. Intraoperatively, marked thinning of the gastric wall and near-total gastric necrosis were observed, necessitating total gastrectomy. Although the patient developed complicating sepsis and liver failure after the surgery, he recovered from the complications following multidisciplinary treatment. In general, gastric necrosis is an unusual condition, as the stomach has a rich blood supply.

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