Gastric Perforation as a Complication of Gastroparesis in a Young Male with Diabetes Mellitus

Published Date: 11th July 2025

Publication Authors: Bagade. N, Paul. A, Kalaiselvan. R

Abstract

Background: Gastroparesis is a syndrome characterized by delayed gastric emptying (GE) and upper gastrointestinal symptoms that suggest, but are not associated with, gastric outlet obstruction. Up to 50% of patients with type 1 and type 2 Diabetes mellitus (DM) and suboptimal glycaemic control have delayed gastric emptying (GE). To our knowledge, gastric perforation as a complication of gastroparesis has not been reported in literature. Clinical scenario: We present a case of a 20-year-old male with poorly controlled type 1 diabetes and gastroparesis admitted under the medical team with Diabetic Keto-Acidosis (DKA). He was referred to General Surgery with acute abdominal pain. He had multiple admissions for DKA in the last 6 years. He underwent CT abdomen pelvis (Fig. 1 and 2) as work up for acute abdomen. Imaging revealed massive pneumoperitoneum with no obvious site of perforation. Emergency laparoscopy was performed. Initial inspection showed massive gastric dilatation and no obvious perforation. On medial mobilisation of the stomach and entry into the lesser sac a*2 cm posterior gastric perforation at fundus with leaking residual food debris was noted. Laparoscopic lavage and closure of the perforation with 00 PDS was carried out. Intraperitoneal drains and nasogastric tube were placed. Total parenteral nutrition was started and gradually weaned off after commencement of Oro-enteral feeding. Patient had an uneventful recovery and discharged with outpatient follow up.
Discussion(s): Gastric perforation from gastroparesis is an unknown complication. Perforation of the stomach has been reported due of acute massive gastric dilatation from mechanical obstruction or bulimia. Gastric ischemia and necrosis occur when the blood supply to the stomach lining is compromised due to the rise in intragastric pressure. This can lead to gastric ulceration and subsequent perforation. The most common site of perforation is along the greater curvature and fundus of the stomach.
Conclusion(s): Recurrent gastroparesis leading to acute gastric dilatations from a medical condition should not be neglected. These patients should be appropriately investigated to identify the underlying cause and prompt management of the condition is recommended. Early recognition and decompression of the dilated stomach is necessary to prevent such complications.

Bagade, N.V.; Paul, A.; Kalaiselvan, R. (2025). Gastric Perforation as a Complication of Gastroparesis in a Young Male with Diabetes Mellitus. Surgical Endoscopy. 39(Supp 2), p.S762. [Online]. Available at: https://dx.doi.org/10.1007/s00464-025-11801-6 [Accessed 12 March 2026].