Hindawi Publishing Corporation Case Reports in Surgery Volume 2013, Article ID 984594, 4 pages http://dx.doi.org/10.1155/2013/984594 Case Report Acute Dilatation, Ischemia, and Necrosis of Stomach without Perforation Manash Ranjan Sahoo, Anil T. Kumar, Sunil Jaiswal, and Siba Narayan Bhujabal Department of Surgery, SCB. Medical College, Cuttack, Odisha 753007, India Correspondence should be addressed to Manash Ranjan Sahoo; manash67@gmail.com Received 28 July 2013; Accepted 27 August 2013 Academic Editors: A. Cho, S. Landen, and M. Picchio Copyright © 2013 Manash Ranjan Sahoo et al. Tis is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Acute gastric dilatation can have multiple etiologies which may lead to ischemia of the stomach. Without proper timely diagnosis and treatment, potentially fatal events such as gastric perforation, haemorrhage, and other serious complications can occur. Here we present a 36-year-old man who came to the casualty with pain abdomen and distension for 2 days. Clinically, abdomen was asym- metrically distended more in the lef hypochondrium and epigastrium region. Straight X-ray abdomen showed opacifed lef hypochondrium with nonspecifc gaseous distension of bowel. Exploratory laparotomy revealed dilated stomach with patchy gangrene over lesser curvature and fundic area. About 4 litres of brownish fuid along with semisolid undigested food particles was sucked out (mainly undigested pieces of meat). Limited resection of gangrenous areas and primary repair were done along with feeding jejunostomy. Necrosis of the stomach was confrmed on histopathology. Te patient recovered well and was discharged on the tenth postoperative day. 1. Introduction Acute gastric dilatation can have multiple etiologies which may lead to ischemia of the stomach. Te etiologies are lifestyle habits, underlying morbidities, acute necrotizing infammation, acute vascular insufciency, and postoperative complications. Without proper timely diagnosis and treat- ment, potentially fatal events such as gastric perforation, haemorrhage, and other serious complications can occur. We here present a rare case of gastric dilatation leading to patchy gangrenes on the surface of stomach and how timely intervention was carried out. 2. Case Report A 36-year-old male patient, referred from periphery hospital with nasogastric tube in place, presented to the casualty with pain abdomen and abdominal distension for two days which was not relieved with conservative treatment. Two days ago he had taken nonvegetarian meal twice, in increased quantity than usual, within a short gap of 3 hours between those two meals. Ten he had two episodes of vomiting 6 hours later. His past history was not signifcant. He was not sufering from any psychiatric illness or any co-morbidity like diabetes and had not undergone any surgeries. His vital parameters were within normal limits. Abdominal examination showed more asymmetrical distension in lef hypochondrium and epigastrium with tympanicity all over the abdomen without signs of peritonitis. Straight X-ray abdomen showed opacifed lef hypochondrium with nonspecifc gaseous distension of bowel (Figure 1). Even afer conservative treatment, when the distension and pain did not subside, he was planned for exploratory laparotomy. Ryle’s tube aspiration in this case was unproductive. On opening the abdomen through upper midline incision it was found that stomach was dilated with patchy gangrene at two areas, one on the lesser curvature (Figure 2) and the other on the fundus of stomach (Figure 3). Handling at the gangrenous area leads to perforation at the lesser curvature which showed that there was impending per- foration in that area. Trough this perforation about, 4 litres of thick brown coloured fuid mixed with undigested food particles (mainly undigested pieces of meat) was sucked out (Figure 4) and removed. Te tip of the nasogastric tube now became visible through the defect (Figure 5). Te gangrenous