A Case of Suspected Abdominal Compartment Syndrome due to Spontaneous Rupture of the Stomach in an Adult

A 47-year-old man was transferred to our emergency room for abdominal pain, vomiting, and loss of consciousness (III-200 on the Japan coma scale). On admission, he was in shock with marked abdominal distention and arterial blood gas analysis showed severe metabolic acidosis. Abdominal contrast enhanced CT scan revealed massive free air and ascites in the abdominal cavity. Contrast enhancement of the liver and bilateral kidneys was poor. An emergency operation was performed. On laparotomy, massive ascites with food debris was observed. The stomach was perforated 8-cm in length on the anterior wall of the fundus and the body, necessitating total gastrectomy with Roux-en-Y reconstruction. The appearance of the liver was whitish and ischemic just after laparotomy. During the operation, the color of the liver returned to normal as the intra-abdominal pressure was decreased, leading to a possible diagnosis of abdominal compartment syndrome. In spite of intensive systemic treatment, the patient died of multiple organ failure on postoperative day 40. Spontaneous rupture of the stomach in adults is rare. The pathophysiological mechanisms include rapid elevation of intra-gastric pressure due to vomiting, extreme dilation of stomach due to bulimia, and necrosis of the gastric wall due to circulative disturbance. In general, the perforation size is larger than that of gastric ulcers and massive leakage of gastric content often results in extreme elevation of intra-abdominal pressure leading to abdominal compartment syndrome with poor outcome.