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A 57-year-old male patient with an unremarkable medical history presented to the emergency department with a 3-day history of abdominal pain, nausea, and vomiting. On performing a physical examination, his abdomen was distended and tender to palpation. Intravenous contrast-enhanced abdominal computed tomography (CT) demonstrated acute gastric and duodenal dilatation (Figure 1a). There was narrowing of the third part of the duodenum between the abdominal aorta and the superior mesenteric artery, suggesting a diagnosis of superior mesenteric artery syndrome (Figure 1b, arrow). There was a wall defect at the posterior surface of the gastric fundus caused by acute gastric dilatation (Figures 1c and 1d, arrows), with free gas and fluid adjacent to the site of gastric perforation (Figures c and d, stars). During surgery, necrosis and a perforation were observed at the gastric fundus (Figure 1e, arrowhead). Primary suturing with an omental patch was done to close the perforation site. Duodenal decompression was performed for drainage. The patient’s postoperative recovery was uneventful.

A Rare Cause and Complication of Acute Gastric Dilatation: Superior Mesenteric Artery Syndrome and Perforation