Journal of Innovative Clinical Trials and Case Reports

Abstract

Abstract: Introduction: Spontaneous gastric rupture is an extremely rare, life-threatening condition with high mortality. Mechanisms include acute gastric overdistension, impaired gastric emptying, and sudden intragastric pressure increases [1–5]. Early diagnosis is challenging, particularly in critically ill patients.

Materials and Methods: We report a 65-year-old female who presented in deep coma after laryngeal and tracheal obstruction by a food bolus with massive aspiration. Clinical assessment included physical examination, laboratory tests, abdominal radiography, chest CT, esophagogastroduodenoscopy (EGD), intraoperative findings, and postoperative course.

Results: On admission, the patient exhibited severe hypoxemia, hemodynamic instability, and mixed-origin shock, with sepsis excluded. Abdominal radiography revealed massive pneumoperitoneum. EGD demonstrated a subcardial linear Mallory–Weiss mucosal tear, insufficient to explain free intraperitoneal gas. Emergency midline laparotomy revealed a 10-cm longitudinal full-thickness rupture along the lesser curvature. Two-layer gastrorrhaphy was performed using 3-0 absorbable polyglactin for the inner layer and 3-0 non-absorbable polypropylene for the outer seromuscular layer. Intraoperative leak test confirmed suture line integrity. Complete abdominal exploration revealed no additional gastrointestinal injuries. Postoperatively, the patient developed severe aspiration-induced lung injury requiring prolonged mechanical ventilation [6–8].

Conclusion: This case illustrates the diagnostic challenges of spontaneous gastric rupture in patients with coma and mixed-origin shock. Early recognition of pneumoperitoneum, meticulous surgical technique, and prompt operative intervention are critical for survival.