Gastric Perforation Secondary to Acute Gastric Dilatation Without an Eating Disorder: A Case Report

Acute gastric dilatation (AGD) is a life-threatening condition that could progress to necrosis and perforation. Most cases are associated with mechanical obstruction or eating disorders; however, spontaneous perforation after a single large meal in patients without prior risk factors is exceptionally rare. A 64-year-old woman with no history of eating disorders was admitted with peritonitis and septic shock, 24 hours after consuming a large meal. Computed tomography showed pneumoperitoneum, free intra-abdominal fluid and a gastric perforation. Emergent laparotomy revealed necrosis and a 6 cm perforation in the anterior gastric wall, requiring partial gastrectomy and feeding jejunostomy. Despite severe initial acidosis and acute kidney injury, the patient recovered fully after 10 days of intensive care. Histopathology confirmed ischemic necrosis without evidence of microorganisms or malignancy. This case highlights that a gastric necrosis caused by AGD can occur even in the absence of classic risk factors. Venous ischemia from intraluminal pressure elevation - rather than arterial insufficiency - was the likely mechanism. Early recognition and surgical intervention are critical to survival.