NECROTIC GASTRIC PERFORATION ASSOCIATED WITH NECROTIZING PANCREATITIS

Objectives: Acute pancreatitis may present with wide range of severity from a self-limiting disease to a rapidly fatal course. Necrotizing pancreatitis is the direst evolution associated with a poor prognosis with mortality approaching 30% in cases of infected necrosis. Acute pancreatitis may lead to stress related gastrointestinal mucosal lesions; however, severe complications such as gastric necrotic perforation are very rare. Here, we report a 52-year-old male who was admitted due to an abdominal pain secondary to recurrent bouts of pancreatitis. During his hospitalization computed tomography was obtained, which demonstrated a contained gastric perforation confined with necrosis and locules of gas as well as walled off necrosis of the colon. The patient underwent total gastrectomy, wide drainage of the abdominal cavity, jejunostomy tube placement and an esophagostomy due to worsening clinical condition. Postoperative findings demonstrated a perforation of the necrotic gastric wall at the region in contact with the necrotic pancreas. After a prolonged hospitalization, patient was subsequently discharged to rehabilitation hospital in stable condition with plans for restoration of intestinal continuity in the future with Roux-en-Y jejunal reconstruction or colon interposition.

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