Invasive Gastric Mucormycosis With Splenic Invasion- A Rare Abdominal Complication

Abstract

 A 57 years old lady, a known case of  Diabetes Mellitus presented in the EMD with complaints of acute onset of shortness of breath for 1 day,  abdominal pain with constipation for 5 days. Patient was drowsy, tachypneic and had tachycardia. Per abdomen examination showed epigastric tenderness. Her sugars were elevated and urine was positive for ketones. ABG revealed metabolic acidosis with dyselectrolemia. She was initialy diagnosed with diabetic ketoacidosis. She was initial diagnosed with diabetic ketoacidosis and admitted in ICU for further evaluation. CECT abdomen showed infarcted spleen with air pocket extending upto the left sub-diaphragmatic region with communicating air pocket to the stomach lumen which was avascular with a perforation. Emergency exploratory Laparotomy was done, Noting extensive necrosis of spleen and stomach wall, so we proceeded with  Total Gastrectomy + Splenectomy + Roux-en-y oesophagojejunostomy + Feeding jejunostomy was done. Postoperatively patient was managed in the surgical ICU with FJ feeds, Total Parentral Nutrition and other supportive measures. Biopsy was suggestive of Invasive gastric mucormycosis with splenic invasion, hence the patient was started on conventional Amphotericin-B.