Acute necrotizing gastritis: A rare and fatal gastrointestinal emergency

Abstract

Introduction and importance

Acute necrotizing gastritis is a rare and life-threatening condition characterized by gastric gangrene in the absence of vascular compromise. Prompt recognition and surgical intervention are critical to prevent fatal complications.

Case presentation

A 30-year-old male presented to the emergency department with a 3-day history of generalized abdominal pain along with coffee-ground vomiting and absolute constipation. Clinical evaluation revealed a febrile, dehydrated, and tachycardic patient with a tense, tender, and distended abdomen. Radiological investigations, including a CT abdomen, demonstrated gastric distension, air-fluid levels, thickened gastric walls, and prominent intramural gas along the greater curvature without evidence of perforation. Endoscopy typically reveals a purplish discoloration of the gastric mucosa, covered with necrotic debris. However, in this case endoscopy was avoided due to strong clinical and radiological suspicion of acute necrotizing gastritis, the patient's hemodynamic instability and potential risk of gastric perforation.

Exploratory laparotomy revealed gangrenous changes involving the fundus and a longitudinal strip of gastric tissue along the greater curvature, with a width around a third of the stomach, sparing the lesser curvature and gastroesophageal junction. The longitudinal strip of gangrenous segment was resected, and the stomach was repaired using a double-layer technique. Histopathology confirmed gastric mucosal necrosis with neutrophilic infiltration, and tissue cultures revealed hemolytic streptococci. The patient’s postoperative recovery was uneventful, and he was discharged on the 12th postoperative day.

Clinical discussion

This case underscores the importance of considering acute necrotizing gastritis as a differential diagnosis in patients presenting with severe abdominal pain, vomiting, and gastric distension, even in the absence of traditional risk factors. Prompt surgical intervention is critical to avoid life-threatening complications.

Conclusion

Further studies are needed to elucidate the pathogenesis and refine the management of this rare condition.