Presentation
Entire pizza consumption on previous night. Abdo pain +++. Lactate 5-10. AXR ?pneumatosis.
Patient Data
The stomach is massively distended with food contents. There is extensive pneumatosis in the gastric wall.
Extensive portal venous gas is demonstrated in the right lobe of the liver. No arterial or venous occlusion is identified.
There is no free intraperitoneal gas. There is moderate free fluid in the pelvis.
No focal parenchymal lesion demonstrated in the liver. The spleen, pancreas, adrenals and kidneys are normal.
Moderate fecal loading demonstrated in the colon with moderate proximal dilatation. No small bowel dilatation.
Conclusion:
Massively distended stomach with extensive pneumatosis and portal venous gas in the liver, likely reflecting venous ischemia and gastric wall necrosis.
There is moderate free fluid but no free gas to suggest perforation
Case Discussion
Gastric ischemia is rare due to the rich vascular network of the stomach. Overdistension (and thereby increased intragastric pressure) is thought to impair the intraluminal circulation, leading to ischemia and then necrosis.