Our Summary

A research paper presents the case of an 18-year-old woman with no previous health problems, who was rushed to the emergency room after experiencing stomach pain and vomiting. This happened after she had used alcohol and cannabis within the last day and a half. Upon examination, doctors found her stomach was bloated, and she showed signs of a serious infection and irritation in the lining of her abdomen.

A CT scan of her abdomen showed swelling in her stomach, esophagus, and the first part of her small intestine. It also revealed air pockets in her stomach and the main vein leading to the liver, as well as fluid free-floating within her abdomen.

Surgeons then performed exploratory surgery, which revealed extensive death of stomach tissue. As a result, they had to remove her entire stomach and reroute her digestive system (a surgery known as a Roux-en-Y anastomosis).

The removed stomach tissue was then examined in a lab. This confirmed that the woman had a severe case of a condition called emphysematous gastritis, where air pockets form in the wall of the stomach, causing tissue death. It was also found that she had an established infection with a bacteria called Sarcina ventriculi.

FAQs

  1. What symptoms led to the diagnosis of gastric necrosis in the 18-year-old woman?
  2. What surgical procedure was performed to address the extensive gastric necrosis?
  3. What did the histopathology of the gastric tissue reveal?

Doctor’s Tip

One helpful tip a doctor might tell a patient about gastrectomy is to follow a strict diet plan recommended by a nutritionist or dietitian. This plan may include smaller, more frequent meals to help with digestion, avoiding certain foods that may be difficult to digest, and focusing on high-protein and nutrient-rich foods to promote healing and overall health. It is important for patients who have undergone a gastrectomy to work closely with their healthcare team to ensure they are meeting their nutritional needs and managing any potential complications that may arise.

Suitable For

Patients who are typically recommended for gastrectomy include those with:

  1. Gastric cancer: Gastrectomy is often recommended as a treatment option for patients with gastric cancer, especially in cases where the cancer is localized and has not spread to other organs.

  2. Peptic ulcer disease: In cases where peptic ulcers do not respond to medical treatment or if there are complications such as bleeding or perforation, gastrectomy may be recommended.

  3. Severe gastric motility disorders: Gastrectomy may be considered for patients with severe gastroparesis or other motility disorders that significantly impact their quality of life and are unresponsive to other treatments.

  4. Refractory gastric ulcers: If a patient has recurrent or refractory gastric ulcers that do not heal with medical management, gastrectomy may be necessary to remove the affected portion of the stomach.

  5. Gastric necrosis: In cases of extensive gastric necrosis, as seen in the case study described above, gastrectomy may be required to remove the necrotic tissue and prevent further complications.

It is important to note that gastrectomy is a major surgical procedure with potential risks and complications, and should only be considered after careful evaluation and discussion with a healthcare provider.

Timeline

  • Before gastrectomy: The patient experiences abdominal pain and vomiting after consuming alcohol and cannabis. She presents to the Emergency Department with abdominal distension, signs of peritoneal irritation, and sepsis. Imaging studies show gastric, esophageal, and duodenal distension, gastric and portal pneumatosis, and free intra-abdominal fluid. An exploratory laparotomy reveals extensive gastric necrosis.

  • After gastrectomy: Total gastrectomy with stapled Roux-en-Y anastomosis is performed to remove the necrotic tissue. Histopathology confirms extensive transmural emphysematous and necrotizing gastritis, as well as the presence of Sarcina ventriculi infection. The patient will undergo a period of recovery and rehabilitation to adapt to life without a stomach, including dietary changes and monitoring for potential complications.

What to Ask Your Doctor

  1. What is the reason for my gastrectomy and what are the potential risks and benefits of the surgery?
  2. How will my digestive system function without a stomach? Will I need to make any dietary changes?
  3. What is the recovery process like after a gastrectomy and how long will it take before I can resume normal activities?
  4. Will I need any additional treatments or follow-up care after the gastrectomy?
  5. What are the potential complications or long-term effects of a gastrectomy?
  6. How will the removal of my stomach affect my overall health and quality of life?
  7. Are there any support groups or resources available for individuals who have undergone a gastrectomy?
  8. How will the surgery impact my ability to digest and absorb nutrients from food?
  9. Will I need to take any medications or supplements after the gastrectomy to prevent deficiencies?
  10. What can I do to minimize the risk of complications and promote healing after the surgery?

Reference

Authors: de Lima Piña GP, Larrea Ramírez A, Fuertes Jiménez C, Cevallos Abad MI. Journal: Rev Esp Enferm Dig. 2023 Mar;115(3):133-135. doi: 10.17235/reed.2022.8767/2022. PMID: 35360912