Gastric Necrosis and Perforation Following Massive Gastric Dilatation in an Adolescent Girl: A Rare Cause of Acute Abdomen

Fatal gastrointestinal complications in Pitt-Hopkins syndrome

Pitt-Hopkins syndrome (PTHS) is a rare neurodevelopmental disorder caused by mutations of the transcription factor 4 (Tcf4) gene. Individuals with PTHS often suffer from severe abdominal bloating and constipation. In this short communication, we discuss two individuals with PTHS who died unexpectedly due to gastrointestinal complications. We aim to increase awareness among healthcare professionals who care for individuals with PTHS, to ensure adequate screening and management of gastrointestinal symptoms in this population. Moreover, we discuss how fatal gastrointestinal complications may be related to PTHS and provide an overview of the literature.

A rare complication of laparoscopic Roux-en-Y gastric bypass: case report of gastric remnant necrosis

Gastric remnant necrosis is a very rare, but potential life-threatening complication after laparoscopic Roux-en-Y gastric bypass (LRYGB). We report a case of gastric remnant necrosis that was complicated by peritonitis and resulted in septic shock in a 49-year-old woman who had undergone a LRYGB three months prior to admission. An emergent laparoscopy with subtotal gastrectomy was performed. The patient was treated for septic shock and could leave the hospital in a good condition. Potential etiological factors for gastric remnant necrosis were elaborated.

A Rare Case of Acute Necrotizing Gastritis

Stomach is a highly vascular organ in the gastrointestinal tract. It is very rare for a stomach to go in for gangrene even in cases of volvulus. Spontaneous gangrene due to acute necrotizing gastritis is a very rare and dreaded condition. This condition is usually not recognized preoperatively due to its rarity. Hence, early diagnosis and prompt expert management are necessary. Here, we present a case of acute necrotizing gastritis which was admitted in our emergency department which was diagnosed to be a case of gastric gangrene preoperatively with the help of radiological investigations.

Necrotic Excluded Gastric Remnant Post Gastric Bypass: A Rare Fatal Complication

We report an unusual case of a 76-year-old woman with a necrotic perforated excluded gastric pouch who had stomach partitioning gastrojejunostomy 20 years earlier for morbid obesity. The necrotic mucosa of the excluded gastric pouch was seen on gastroscopy with retrograde cannulation from the pylorus. Laparotomy revealed a distended excluded stomach with full-thickness ischaemia of the posterior wall with perforation into the lesser sac. Partial gastrectomy with Roux-en-Y gastrojejunostomy was performed. We strongly suggest early surgical exploration for these patients when they are hemodynamically unstable or do not have a precise diagnosis despite imaging to prevent potentially life-threatening gastric pouch necrosis. We advocate for avoiding risk factors like alcohol, nicotine, and nonsteroidal anti-inflammatory drugs (NSAIDs) and implement preoperative Helicobacter pylori testing and its eradication to reduce the incidence of perforation in the excluded pouch.

Acute Gastric Necrosis in a Teenager

Gastric infarction is a rare condition often associated with high mortality due to a delay in diagnosis. The stomach which has a rich supply of blood is a rare site for such a condition. Gastric infarction has a long list of etiological factors. We report a case of a patient who was managed successfully following gastric infarction from gastric dilatation. An 18-year-old female student presented with a three-day history of abdominal pain associated with abdominal distension of two days. The abdomen was distended with generalized tenderness, rebound tenderness, and guarding. Bowel sounds were absent. Digital rectal examination was unremarkable, and a pregnancy test was negative. Biochemical tests were all normal. Intraoperatively, two litres of serosanguinous fluid was suctioned from the abdomen. About 300 mL of pus was suctioned from the pelvis. The gangrenous portion was resected, and repair was done in two layers using Conell and Lambert suture techniques. Acute gastric necrosis is a rare surgical condition that requires a high index of suspicion and prompts aggressive resuscitation and surgical intervention to obviate the high mortality rate associated with the condition.

Massive gastric distension due to signet-ring cell gastric adenocarcinoma

Chronic massive gastric distention is a rare condition that can occur due to an underlying obstruction or dysmotility. Gastric outlet obstruction (GOO) is often the culprit that can manifest as the result of the luminal, mural, or extrinsic compression. Gastric adenocarcinoma can rarely manifest as massive gastric distention due to partially obstructing mass or peptic stricture. Severe and fatal sequelae may develop, if early detection and appropriate intervention are delayed, such as gastric decompression, endoscopic evaluation and/or surgical resection. Herein, we present a case of a 60-year-old male who presented with progressive worsening of nonspecific symptoms over the 8-month period. He was found to have remarkable massive gastric distention on imaging which was chronic in etiology secondary to GOO due to metastatic signet-ring cell gastric adenocarcinoma.

Case report of extreme gastric distention and perforation with pathologic Sarcina ventriculi colonization and Rett syndrome

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Rett syndrome is associated with pathologic aerophagia.

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Rett syndrome associated aerophagia can lead to gastric perforation.

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Sarcina ventriculi colonization is also a risk factor for gastric perforation.

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It is unknown how Sarcina ventricula colonization and Rett syndrome interact as risk factors for gastric perforation.

Here we describe a case of a 15-year-old child with Rett syndrome who presented with extreme gastric distension and fatal perforation in the setting of long-standing aerophagia and pathologic colonization with Sarcina ventriculi, a rare bacteria implicated in gastric perforation. This is the first report of gastric perforation associated with colonization by Sarcina in a patient with pathologic aerophagia. Gastric colonization with Sarcina should be considered in intellectually disabled children with pathologic air swallowing who present with severe gastric dilation and/or perforation.