Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 4 1 2019 08 11 e13 e13 Mohammad Ashouri Department of Surgery, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran Payam Vezvaei Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran Alireza Kazemeini Department of Surgery, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran Alborz Sherafati Department of Cardiology, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran Hadi Mirfazaelian Department of Emergency Medicine, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran 2019 06 15 2019 07 19 Introduction: Acute gastric dilation following trauma is an unusual event that can occur in different settings, and can cause gastric necrosis as a rare though fatal condition. The present report involves a case of acute gastric dilation following multiple traumas, which caused gastric necrosis and total gastrectomy. Case presentation: A 19-year-old morbid obese male presented to the emergency department (ED) following a motor vehicle accident. He had a left lower extremity crash injury. In his serial examinations, he was complaining of upper abdominal pain with epigastric tenderness. After nasogastric tube (NGT) reinsertion, due to detecting coffee ground secretions in the drained fluid, the patient was transferred to the operating room. A midline laparotomy was performed that revealed dilation and discoloration of the stomach. Gastric decompression was performed. All the discoloration then disappeared except for that of certain suspicious areas, which necessitated evaluations. On the following day, given the lack of improvement in the patient`s condition, he was transferred to the operating room for a second laparotomy. Conclusion: The present report emphasized on the importance of NGT insertion in multiple-trauma patients, which is, however, neglected in many cases. Moreover, acute gastric dilation is recommended to be considered in the differential diagnosis of patients with multiple or abdominal trauma and complaints of vomiting or abdominal pains. https://fem.tums.ac.ir/index.php/fem/article/view/192 https://fem.tums.ac.ir/index.php/fem/article/download/192/203