Fatal pediatric gastric ischemia following accidental substance exposure; case report and review of literature

Abstract Background Although the stomach has an extensive blood supply and collateral circulation, gastric necrosis may result from volvulus, acute gastric dilatation, or systemic conditions that promote blood stagnation and thrombosis. Here we report a case of a previously healthy 12-year-old female who presented with gastric ischemia and necrosis secondary to undisclosed toxicological exposure. Case presentation A twelve-year-old female presented to the emergency department in a state of total systemic collapse, altered level of consciousness following an acute onset of vomiting and severe abdominal pain. There was no significant medical or surgical history. Toxicology screening was positive for both cannabis and benzodiazepines. After resuscitation, urgent laparotomy revealed ischemic stomach involving the fundus and the greater curvature which necessitated partial gastrectomy. However, the clinical course was complicated by fatal multiorgan dysfunction on postoperative day seven. Conclusion Gastric ischemia is a rare but critical pediatric emergency carrying a mortality rate up to 40%. Substance-induced vasospasm should be considered in suspicious conditions. Immediate hemodynamic stabilization and urgent surgical intervention remain the mainstay to control the fatal outcomes.