Acute massive gastric dilatation with necrosis and portal vein gas accumulation-a case report

Acute gastric distension (AGD) is a rare but life-threatening acute abdominal condition. Despite the rich blood supply to the stomach, extreme distension can lead to ischemic necrosis, perforation, and gas accumulation in the portal vein, with a mortality rate as high as 80-100%. We report the case of a 15-year-old male patient who presented with severe abdominal pain, bloating, and vomiting following a binge-eating episode. Physical examination revealed signs of diffuse peritonitis and shock (heart rate 154 beats per minute). Laboratory results showed severe metabolic acidosis (pH 7.265) and hyperlactatemia (11.3 mmol/L). An abdominal CT scan confirmed massive gastric distension and gas accumulation in the portal vein, biliary tract, and esophageal wall. The patient underwent emergency laparotomy within 2 hours of admission. Intraoperatively, the stomach was found to be distended into the pelvic cavity, with two areas of hemorrhagic necrosis: one on the lesser curvature (4 cm × 5 cm) and another on the posterior wall of the greater curvature (3 cm × 4 cm). Gastric decompression, debridement of the necrotic areas, and creation of a gastrostomy were performed. After 5 days of intensive care unit (ICU) monitoring (for treatment of septic shock), the patient recovered well and was discharged on the 14th postoperative day; follow-up revealed no recurrence. This case demonstrates that even healthy individuals without eating disorders may develop AGD due to acute binge eating. Portal air is a critical warning sign of mucosal necrosis. Early diagnosis via CT and prompt surgical decompression are key to saving the lives of patients with ischemia and shock.