Gastric necrosis complicating acute gastric dilatation after Nissen fundoplication.

A woman in her 70s was referred for the management of complex intestinal fistulation, which had developed as a postoperative complication of laparoscopic Nissen fundoplication. Surgical treatment of a jejunocolocutaneous fistula and formation of a double-barrelled ileocolostomy was undertaken uneventfully. Routine postoperative nasogastric intubation was not undertaken. On the seventh postoperative day she had nausea and hiccupping. A chest x-ray demonstrated a massively dilated stomach which was decompressed with a nasogastric tube. The patient sustained a cardiac arrest and was resuscitated. A subsequent CT scan demonstrated acute gastric necrosis but the patient was judged too unwell for surgical intervention and died. Postmortem examination revealed emphysematous gastric necrosis. This case highlights the potentially fatal consequences of acute gastric dilatation following major abdominal surgery in patients who have previously had a Nissen fundoplication and are consequently unable to vomit.