Isolated Total Gastric Necrosis Following Coronary Artery Bypass: A Rare and Life-Threatening Complication

Acute gastric necrosis is an exceptionally rare condition, attributed to the stomach’s rich vascular supply. While often linked to gastric dilatation or mesenteric ischemia, isolated total gastric necrosis without bowel involvement is highly unusual. A 73-year-old male presented with acute abdomen on postoperative day 10 following coronary artery bypass grafting (CABG). He was on systemic anticoagulation. Laboratory findings revealed leukocytosis, renal dysfunction, and coagulopathy. CT imaging showed free air around the stomach. Emergency laparotomy revealed isolated total gastric necrosis without gastric dilatation or small bowel involvement. Total gastrectomy with Roux-en-Y esophagojejunostomy was performed. Histopathology showed full-thickness necrosis with ischemic and inflammatory changes but no vascular occlusion or NSAID-induced damage. The patient recovered well and was discharged on postoperative day 24. Despite robust collateral circulation, gastric ischemia can occur under certain systemic conditions such as recent cardiac surgery, anticoagulation, and cardiovascular compromise. In our case, the absence of other ischemic organ damage makes this presentation unique. Early signs are often nonspecific, and diagnosis is frequently delayed, contributing to high mortality. Isolated gastric necrosis, though rare, should be considered in post-CABG patients with acute abdominal symptoms. Early recognition and surgical intervention are vital for survival.