MULTIPLE GASTRIC PERFORATIONS IN A YOUNG PATIENT: A CASE REPORT AND REVIEW OF THE LITERATURE jess6003@gmail.com

PW02-02

MULTIPLE GASTRIC PERFORATIONS IN A YOUNG PATIENT: A CASE REPORT AND REVIEW OF THE LITERATURE

3

South Africa

Oral only

Gastric perforations have multiple known aetiologies and they differ between different cultures and countries. Varicella Zoster Virus (VZV) as a cause of gastric perforations is uncommon. The ability of VZV to establish latency in the Enteric Nervous System (ENS) means that some cases of unexplained gastric perforation could indeed be caused by its reactivation.[1] The case presented is of an immune-competent male, with an atypical cutaneous rash, who presented with multiple gastric perforations. It serves to highlight the importance of awareness of this specific aetiology of gastric perforation as well as the issues with diagnosis in the African context.

We evaluated a patient who presented with a generalised rash (face, trunk and all four limbs) and coughing, shortness of breath and generalised abdominal pain associated with nausea and vomiting. He underwent an emergency laparotomy which demonstrated three gastric perforations. Intra-operative or postoperative biopsies were not possible due to resource constraints. Laboratory testing revealed an active Varicella Zoster infection.

VZV in the GI tract can present with “enteric zoster” which typically encompasses severe abdominal pain with or without gastric ulceration.[1] Since our patient presented with multiple perforations, it is reasonable to infer a systemic cause rather than a localised or isolated cause for the pathology.

Our case illustrates a systemic challenge in low-resource settings, in that not all patients can be afforded a full aetiological work up for all surgical conditions. This represents a potential gap in the literature and possible under-reported incidence of VZV-related GI tract manifestations.