A Case Report of Drug-Induced Acute Gastric Necrosis

The stomach has a rich blood supply; for this reason, acute gastric necrosis is a rare clinical condition and needs a high index of suspicion, especially in those patients having no history of an eating disorder and no signs of gastric distension on radiological investigations. We report on a 23-year-old male patient who presented to the emergency department with a one-day history of severe abdominal pain and multiple episodes of vomiting. On examination, his heart rate was 110 beats per minute. He had a non-distended, tense, and tender abdomen, localized to the epigastrium. He gave a history of drug abuse with recreational drugs (heroin, cannabis, and benzodiazepines). During resuscitation, the nasogastric tube yielded an aspirate of about 1 L of dark-colored hemorrhagic fluid. There was no gas under the diaphragm on the erect abdominal X-ray. Six hours post-admission and resuscitation, exploratory laparotomy was performed due to sepsis. During surgery, 250 mL of brownish-red fluid was drained from the peritoneal cavity. Most of the body of the stomach along the greater curvature was gangrenous from the angle of His up to the incisura angularis along the greater curvature. The left gastric and gastroepiploic arteries were found clotted, while the pulsations of other feeding arteries were normal. A sleeve gastrectomy was performed following the resection of the gangrenous portion. Postoperative recovery, initially in the ICU and subsequently in the surgical ward, was uneventful. On follow-up, no weight loss or nutritional deficiency was observed.