A rare case of idiopathic gastric rupture in an elderly female.

Idiopathic gastric rupture due to causes other than trauma, acid or alkali ingestion, ulceration, or cancer is rare in adults and has a poor prognosis. The patient, an 84-year-old female, was rushed to the emergency department with pronounced upper abdominal pain and underwent enhanced CT, which revealed a large amount of intra-abdominal free gas and marked retention of the gastric contents, thinning of the gastric wall and loss of contrast effect on the gastric wall. We diagnosed upper gastrointestinal perforation and performed an emergency laparotomy. Intraoperative findings revealed that the anterior wall of the lesser curvature was necrotic and perforated. Because of the patient’s poor general condition, we sutured the perforated gastric wall and irrigated and drained the intraperitoneal space first. Then, the patient’s condition was stable, but we performed a simple total gastrectomy because the CT scan on postoperative day 7 showed the dehiscence of the suture closure. The resected specimen revealed no pathological evidence of peptic ulcers or malignancy, so the patient was diagnosed with idiopathic gastric rupture. Idiopathic gastric rupture in adults is a more severe condition with a poorer prognosis than upper gastrointestinal perforation due to peptic ulcers. In this report, we describe a case of idiopathic gastric rupture in an adult patient who was successfully treated with two-stage emergency surgery.