Gastric Necrosis Due to Small Bowel Obstruction: A Case Report

Gastric necrosis is a rare entity due to the normal anatomy of the stomach; the irrigation of the stomach is abundant and has vast collateral irrigation that prevents necrosis from happening in normal situations. Gastric ischemia doesn't happen even if arterial occlusion occurs; however, a venous occlusion caused by an increase in intragastric pressure (measured >20 cm H2O in some experiments) that surpasses gastric venous pressure can precipitate necrosis of the stomach. Here we present the case of a 79-year-old woman with a history of chronic smoking, Alzheimer's dementia, systemic hypertension, hypothyroidism, chronic constipation, and a hysterectomy performed 25 years ago. An exploratory laparotomy was performed with the following findings: 3 liters of fecaloid fluid in the abdominal cavity, 70% necrosis of the stomach affecting major curvature and 80% of the fundus without compromising the cardia, a perforation in the anterior portion of the stomach with a diameter of 6 cm, a right femoral hernia with small bowel entrapment, intestinal obstruction with dilated small bowel; and intestinal necrosis of 7 cm of the ileum that was inside the femoral hernia. A vertical gastrectomy for the necrotic stomach and intestinal resection with termino-terminal anastomosis in the affected segment of the ileum were performed. The patient had a poor response to treatment and finally died 72 hours after surgery due to abdominal sepsis. This report shows that gastric necrosis, although rare, can be a cause of acute abdominal pain. It highlights the importance of a good clinical examination and imaging studies in detecting the causes of small bowel obstruction and offering prompt diagnosis and treatment to patients with small bowel obstruction.