Cakiroglu OF, Gurbuz J, Taslidere B, Cander B. Posterior gastric wall perforation and acute kidney injury after upper endoscopy with esophageal dilation: A case report. World J Clin Cases 2026; 14(27): 126787 [DOI: 10.12998/wjcc.126787]
Corresponding Author of This Article
Julide Gurbuz, Consultant, Department of Emergency Medicine, Bezmialem Foundation University, Vatan Street, Fatih, İstanbul 34093, Türkiye. jultyilmaz@gmail.com
Research Domain of This Article
Emergency Medicine
Article-Type of This Article
case-report
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Cakiroglu OF, Gurbuz J, Taslidere B, Cander B. Posterior gastric wall perforation and acute kidney injury after upper endoscopy with esophageal dilation: A case report. World J Clin Cases 2026; 14(27): 126787 [DOI: 10.12998/wjcc.126787]
Omer Faruk Cakiroglu, Department of Emergency Medicine, Kartal City Hospital, İstanbul 34865, Türkiye
Julide Gurbuz, Bahadir Taslidere, Department of Emergency Medicine, Bezmialem Foundation University, İstanbul 34093, Türkiye
Basar Cander, Department of Emergency Medicine, Bezmialem Vakif University, Istanbul 34093, Türkiye
Co-first authors: Omer Faruk Cakiroglu and Julide Gurbuz.
Author contributions: Gurbuz J designed the report and conceived the study; Cakiroglu OF collected and processed the clinical data and performed the literature search; Gurbuz J analyzed and interpreted the data; Cakiroglu OF and Gurbuz J wrote the manuscript; Taslidere B supervised the work; Cander B critically revised the manuscript for important intellectual content; and all authors have read and approved the final manuscript.
AI contribution statement: Portions of this manuscript were edited using AI tools solely for language refinement. The authors carefully reviewed and verified all AI-assisted outputs and take full responsibility for the scientific content of the manuscript.
Informed consent statement: Written informed consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All authors declare that they have no conflict of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Corresponding author: Julide Gurbuz, Consultant, Department of Emergency Medicine, Bezmialem Foundation University, Vatan Street, Fatih, İstanbul 34093, Türkiye. jultyilmaz@gmail.com
Received: August 13, 2026 Revised: September 16, 2026 Accepted: October 10, 2026 Published online: September 26, 2026 Processing time: 61 Days and 19 Hours
Abstract
BACKGROUND
Perforation is a rare but potentially fatal complication of upper gastrointestinal endoscopy, particularly when therapeutic maneuvers are performed. Posterior gastric wall perforation is particularly difficult to recognize because it may decompress into the lesser sac rather than the free peritoneal cavity and therefore produce subtle or atypical peritoneal signs. We report a 64-year-old male with a history of laryngectomy and radiotherapy for laryngeal carcinoma, advanced thoracolumbar scoliosis, atrial fibrillation, and a tracheoesophageal voice prosthesis who was found to have a posterior gastric wall perforation three days after an upper gastrointestinal endoscopy that included bougie dilation of an esophageal stricture and gastric biopsies.
CASE SUMMARY
On emergency department admission, the patient presented with a blood pressure of 84/50 mmHg, metabolic acidosis, and anuria, suggesting septic shock. Serum creatinine had risen from a documented baseline of 1.1 mg/dL to 4.18 mg/dL, corresponding to Kidney Disease: Improving Global Outcomes stage 3 acute kidney injury (AKI). Contrast-enhanced abdominal computed tomography demonstrated discontinuity of the posterior wall of the gastric corpus, with extravasation of contrast material into the retrogastric space and lesser sac, together with widespread free intraperitoneal air and fluid. AKI was considered predominantly sepsis-associated ischemic acute tubular injury (ATI); contrast exposure seven days earlier was regarded as a possible but unproven contributory factor. The patient underwent two surgical interventions—gastric wedge resection with feeding jejunostomy and re-laparotomy with small bowel resection, double-barrel ileostomy, and surgical gastrostomy due to a jejunostomy-related bile leak. Despite maximal intensive care unit support, the patient died on the 16th day of admission.
CONCLUSION
Posterior gastric perforation may present with minimal peritoneal signs in patients with altered anatomy and impaired communication, and AKI in this setting is usually multifactorial, dominated by sepsis-associated ischemic ATI.
Core Tip: Posterior gastric wall perforation is a rare, easily missed complication of upper gastrointestinal endoscopy because it may decompress into the lesser sac rather than the peritoneal cavity. In this high-risk patient, the endoscope had to be advanced posterior to a migrated tracheoesophageal voice prosthesis during a session that also included esophageal bougie dilation, while thoracolumbar scoliosis, pectus carinatum, and nonverbal status masked peritonitis for 72 hours. The accompanying acute kidney injury (AKI) was multifactorial, most consistent with sepsis-associated ischemic acute tubular injury rather than contrast-associated AKI. Early cross-sectional imaging may be warranted when high-risk patients deteriorate after endoscopy.
