High altitude area – A risk factor for gastric perforation? : A case series

•Original study.•Based on an interesting variation in location of perforated peptic ulcers observed in soldiers posted to high altitude areas.•Literature review and research suggestive of possibility of high altitude induced patho-physiological changes behind gastric perforations.•This study is probably first of it’s kind and may be pioneering for encouraging further studies to establish a definite role of high altitude in causing gastric perforations. This is an original case series on soldiers evacuated from HAA(High Altitude Area) over last one year(Sept 2017–Aug 2018), of which 100% cases were found to have gastric antrum perforation. This is a deviation from the usual trend that is being noted in Indian subcontinent where duodenal perforations are commonest. High altitude associated dyspepsia is a common phenomenon and some studies done in high altitude population have recorded high incidence of antral gastritis and mucosal atrophy on histo-pathological evaluation. This is also supported by high incidence of H. pylori infection. The presence of atrophic gastric mucosa associated with antral gastritis, when exposed to hypobaric hypoxemic conditions faced by soldiers posted to heights above 15,000 ft, may leads to increased intra-luminal pressure and ischemia which probably predisposes individuals for gastric antrum perforations. This is a relatively untouched topic as we have not found studies onhigh altitude related gastric perforations and probably this is the first case series of its kind. The acknowledgement of this phenomenon may pave way for further studies for defining the role of high altitude in gastric perforations.