{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T04:54:29Z","timestamp":1781844869780,"version":"3.54.5"},"reference-count":20,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T00:00:00Z","timestamp":1781827200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:p>Acute gastric distension (AGD) is a rare but life-threatening acute abdominal condition. Despite the rich blood supply to the stomach, extreme distension can lead to ischemic necrosis, perforation, and gas accumulation in the portal vein, with a mortality rate as high as 80\u2013100%. We report the case of a 15-year-old male patient who presented with severe abdominal pain, bloating, and vomiting following a binge-eating episode. Physical examination revealed signs of diffuse peritonitis and shock (heart rate 154 beats per minute). Laboratory results showed severe metabolic acidosis (pH 7.265) and hyperlactatemia (11.3\u202fmmol\/L). An abdominal CT scan confirmed massive gastric distension and gas accumulation in the portal vein, biliary tract, and esophageal wall. The patient underwent emergency laparotomy within 2\u202fhours of admission. Intraoperatively, the stomach was found to be distended into the pelvic cavity, with two areas of hemorrhagic necrosis: one on the lesser curvature (4\u202fcm\u202f\u00d7\u202f5\u202fcm) and another on the posterior wall of the greater curvature (3\u202fcm\u202f\u00d7\u202f4\u202fcm). Gastric decompression, debridement of the necrotic areas, and creation of a gastrostomy were performed. After 5\u202fdays of intensive care unit (ICU) monitoring (for treatment of septic shock), the patient recovered well and was discharged on the 14th postoperative day; follow-up revealed no recurrence. This case demonstrates that even healthy individuals without eating disorders may develop AGD due to acute binge eating. Portal air is a critical warning sign of mucosal necrosis. Early diagnosis via CT and prompt surgical decompression are key to saving the lives of patients with ischemia and shock.<\/jats:p>","DOI":"10.3389\/fmed.2026.1796420","type":"journal-article","created":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T04:29:50Z","timestamp":1781843390000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Acute massive gastric dilatation with necrosis and portal vein gas accumulation\u2014a case report"],"prefix":"10.3389","volume":"13","author":[{"given":"Xiaoxu","family":"He","sequence":"first","affiliation":[{"name":"Qujing Second People\u2019s Hospital","place":["Qujing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun","family":"Wang","sequence":"additional","affiliation":[{"name":"Qujing Second People\u2019s Hospital","place":["Qujing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yongjiang","family":"Zhao","sequence":"additional","affiliation":[{"name":"Qujing Second People\u2019s Hospital","place":["Qujing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shumin","family":"Ma","sequence":"additional","affiliation":[{"name":"Qujing Second People\u2019s Hospital","place":["Qujing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhiping","family":"Wang","sequence":"additional","affiliation":[{"name":"Qujing Second People\u2019s Hospital","place":["Qujing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bo","family":"Chen","sequence":"additional","affiliation":[{"name":"Qujing Second People\u2019s Hospital","place":["Qujing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yongliang","family":"Yao","sequence":"additional","affiliation":[{"name":"Qujing Second People\u2019s Hospital","place":["Qujing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,19]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"185","DOI":"10.1002\/ccr3.2577","article-title":"Superior mesenteric artery syndrome in severe anorexia nervosa: a case series","volume":"8","author":"Watters","year":"2020","journal-title":"Clin Case Reports"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"304","DOI":"10.4103\/0974-2700.66564","article-title":"Acute idiopathic gastric necrosis, perforation and shock","volume":"3","author":"Vettoretto","year":"2010","journal-title":"J Emerg Trauma Shock"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"709","DOI":"10.1177\/000313480006600801","article-title":"Acute gastric dilatation revisited","volume":"66","author":"Todd","year":"2000","journal-title":"Am 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