TITLE: Double Pathology in a Fragile Stomach: Caustic Gastric Perforation with Coexisting Tumor in a Low-Resource Setting

TITLE: Double Pathology in a Fragile Stomach: Caustic Gastric Perforation with Coexisting Tumor in a Low-Resource Setting | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report TITLE: Double Pathology in a Fragile Stomach: Caustic Gastric Perforation with Coexisting Tumor in a Low-Resource Setting Shu Bonu, David Cyubahiro This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9260012/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 8 You are reading this latest preprint version Abstract A 57-year-old female with no relevant past medical and surgical history presenting with abdominal distention, epigastric pain and post-prandial vomiting. She was in septic shock at arrival. She was found to have a rare co-existence of a gastric tumor and caustic gastric perforation intra-operatively. Management with damage control surgery and medical management protocols in a severely resource-constraint rural hospital, but sadly didn’t survive. This article highlights the rarity of the occurrence of caustic gastric perforation in the setting of a possibly already existing gastric tumor. Obstipation caustic injury gastric perforation gastric tumor low resource setting. Figures Figure 1 Figure 2 Figure 3 Figure 4 INTRODUCTION Gastric perforation is a very common surgical pathology which is a full thickness injury to the stomach wall that creates an abnormal communication between the stomach and peritoneal cavity. This causes the spillage of gastric content into an environment where they are not usually welcomed causing peritonitis in those affected. A recent multicenter study done in the United States revealed the main causes to be peptic ulcer disease, trauma, iatrogenic and about 30% being secondary to malignancy [1]. Ingestion of acidic or alkaline corrosive agents poses a major problem in public health and more so in developing countries. Health conditions, mental issues like suicide and economic difficulties are among some of the reasons postulated that cause people to ingest these substances. Caustic injury to the gastrointestinal tract occurs commonly in children with accidental ingestions amounting to 80% of cases seen worldwide [2]. Zargar classification is an endoscopic classification used to grade the degree of mural involvement with grade V representing perforation. Acidic corrosive agents are the main culprits in the developed world while alkaline are the majority of cases in the developing world like India and Rwanda, however these agents rarely cause gastric perforation in those affected [2]. Sati et al described a rare case of caustic induced necrosis in Doha [3]. Cases of caustic gastric perforations are largely underreported in sub-Saharan Africa. A 2025 descriptive cross-sectional study spanning almost 7 years in a teaching hospital in Ouagadougou reported a hospitalization rate of caustic injury to be 1.8% with 33 cases out of 1796 identified and the stomach being the most affected portion of the digestive tract [4]. Only 1 case of perforation (Zargar class V) was identified in this study. There is no reported case of this pathology in Rwanda, talk less of it co-existing with gastric tumor. CASE Our patient is a 57-year-old farmer from a rural catchment area in the Eastern Province of Rwanda, with no known chronic disease or relevant past surgical history who presented to the emergency department of Kibungo level 2 Teaching Hospital with complaints of abdominal distension, multiple episodes of vomiting, obstipation and sudden onset of excruciating abdominal pain prominent at the epigastric region of 3 days duration. She reported significant weight loss, recurrent epigastric pain of over 1 month duration for which she patronized traditional healers and was given herbal concoction. She consumed an estimate of about 500mls of the herbal mixture daily over the period of 1 month till 3 days prior to her presentation. She denied smoking tobacco or consumption of alcoholic beverages. Physical examination at arrival revealed a conscious, moderately dehydrated, lethargic and cachectic middle age woman with unrecordably low blood pressure, tachycardia of 120 beats per min (bpm), oxygen saturation of 88% in room air and a temperature of 36C. Abdominal examination was remarkable for a grossly distended abdomen which was tensed with rebound tenderness, hyper-resonant percussion note and absent bowel sounds. Digital rectal exam revealed small quantity of soft stool with an unremarkable vaginal examination. Our initial clinical impression was that of Septic shock on peritonitis secondary to possible gastric perforation. 2 wide-bore (G-18) cannulas were placed with blood drawn up for investigations, IV antibiotics (ceftriaxone and metronidazole) and paracetamol were administered. Fluid resuscitation with Ringer’s Lactate 1 liter commenced immediately. A plain erect abdominal x-ray was ordered for preliminary radiologic guidance. Blood workup revealed a significantly raised liver function assay of ALT AND AST of 446 and 392U/L respectively, hypokalemia at 2.86mmol/L, urea and creatinine were within normal and Full blood count parameters were all within normal range. Plain abdominal x-ray revealed significant air under both hemi-diaphragms with rectal gas absence. Patient was wheeled to the theatre for an emergency exploratory laparotomy. Intra-operative findings were that of multiple areas of gangrene and necrotic gastric tissue on the anterior and posterior surface of the stomach with a large gastric defect of about 10cm on the anterior stomach wall with dark colored gastric content containing food particles like green leafy vegetables. A palpable prepyloric mass could also be felt measuring about 2x 3cm with no adherence to nearby structures. Intra-operatively the patient was persistently hypotensive despite use of vasopressors (noradrenaline). Prompt discussion with the anesthesia team about the possibility of the patient sustaining a demanding gastrectomy and anastomosis was initiated. Considering the poor clinical picture, damage control was opted for with 2 intestinal clamps used to closely the large defect after washout with about 3 liters of normal saline and single layer closure of abdominal wall for possible relook in 24-48hours if the patients clinical state improves. No tissue was taken for histopathology studies as there were no histopathology services in our hospital. There was also no available intensive care unit so patient was kept in the theater recovery room for the entire post-operative period. Post-operatively patient was placed on antibiotics, IV fluids, IV esomeprazole, analgesics and vasopressors. Hemodynamic status didn’t improve. Attempts were made to transfer the patient to a higher center with an ICU to no avail. The clinical psychologist was invited to counsel the patient and relatives about the poor prognosis of her condition. About 36 hours post-op the patient succumbed to her illness and was declared clinically dead with probable cause being septic shock with multiorgan failure. DISCUSSION Caustic ingestion be it accidental or intentional is a common presentation in most emergency departments of hospitals in Rwanda across all age groups particularly among adolescents and young adults for various socioeconomic and emotional reasons. Our patient had recurrent epigastric pain, post-prandial vomiting and weight loss. These symptoms signal a possible gastric pathology and, in this case, probably symptoms in keeping with a gastric tumor. Commonly for socioeconomic reasons patients with patronize traditional healers with unknown herbal concoctions with varying pH handed to them as their only way out. Delayed presentation might be attributed to poverty, illiteracy, poor health education and trust in the traditional doctors. With repeated high-volume ingestion of the herbal mixture and exposure of the stomach wall to unknown offending agents this might have culminated to the rare and surprising intra-operative findings. Lack of adequate health infrastructure like histopathology services impacted diagnosis, lack of ICU made it difficult to offer adequate management despite the prognosis of the patient. This case highlights the dual occurrence of a rare pathology and a common pathologic precedence of gastric perforation, diagnostic and management gaps in a resource-anemic setting signifying that early presentation, high index of suspicion and timely surgical intervention are critical for handling such cases. CONCLUSION Co-existence of a gastric tumor and caustic gastric perforation is extremely rare. For clinicians practicing in resource constraint settings, a thorough and detailed history, sound clinical examination and maintaining a high index of clinical suspicion in setting of patients presenting with recurrent epigastric pain and history of intake of unknown substances prior to presentation is required to identify and possibly manage these cases. Declarations CONSENT TO PARTCIPATE The authors obtained Informed consent from the patient and caregivers for the surgical procedure and to write this case report while keeping privacy and confidentiality. Attached to supplementary materials and related files. CONSENT TO PUBLISH The authors obtained Informed consent from the patient and caregivers for the publication of this case report while keeping privacy and confidentiality. It is attached to supplementary materials and related files. All the authors also approved and consented to the publication of this work. FUNDING DECLARATION The authors received NO FINANCIAL SUPPORT for the research, authorship and/or publication of this article. AUTHORS CONTRIBUTIONS Both authors jointly wrote the entire paper with the corresponding author (Shu Bonu) writing the abstract, case and discussion. The second author (David Cyubahiro) wrote the introduction part of the discussion and conclusion. CLINICAL TRIAL NUMBER ; NOT APPLICABLE ETHICS DECLARATION ; NOT APPLICABLE ACKNOWLEDGEMENTS NOT APPLICABLE AUTHORS INFORMATION Shu BONU and David Cyubahiro are second-year General Surgery residents at the African Health Science University Rwanda currently serving in Kibungo levl 2 Teaching Hospital in the Eastern Province of Rwanda. References National Center for Biotechnology Information. Caustic ingestions. In: StatPearls. StatPearls Publishing; 2023. Available from: https://www.ncbi.nlm.nih.gov/books/NBK519554/ Contini S, Scarpignato C. Caustic injury of the upper gastrointestinal tract: a comprehensive review. World J Gastroenterol. 2013;19(25):3918–3930. doi: 10.3748/wjg.v19.i25.3918 Sati WO, Abdow M, Sabir DM, Elhassan H, Salem W. Acute gastric necrosis induced by caustic substance ingestion: a case report. Cureus. 2024;16(11):e74719. doi: 10.7759/cureus.74719 Sanne ZS, et al. Management of caustic ingestion and its complications in a low-resource setting. Open J Gastroenterol. 2025;15(4):117–125. doi: 10.4236/ojgas.2025.154010 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 10 May, 2026 Reviewers agreed at journal 10 May, 2026 Reviewers agreed at journal 10 May, 2026 Reviewers invited by journal 28 Apr, 2026 Editor invited by journal 08 Apr, 2026 Editor assigned by journal 06 Apr, 2026 Submission checks completed at journal 06 Apr, 2026 First submitted to journal 29 Mar, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9260012","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":635782132,"identity":"2b5637fe-44e4-4912-92c0-6009e2a5a794","order_by":0,"name":"Shu Bonu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAu0lEQVRIiWNgGAWjYBACNgkQycMgB6IOPCBFizFYSwJR1khAqMQGEEmUFj7p5mOPeWTupc8PO/wQaIudnG4DIYfJHEs35uEpzt14O80AqCXZ2OwAIS0SOWbSPDwJuRtnJ4C0HEjcRqyWdMPZ6R9I05IgL51DrC0yx9Ik5/AkGG6Qzik4kGBAhF/kZzcfk3jbkyAvPzt984cPFXZyBLWAAWMPA4MBWKUBMcrB4AfQugaiVY+CUTAKRsFIAwBwHz2qKSIajQAAAABJRU5ErkJggg==","orcid":"","institution":"Africa Health Sciences University Rwanda","correspondingAuthor":true,"prefix":"","firstName":"Shu","middleName":"","lastName":"Bonu","suffix":""},{"id":635782133,"identity":"a2d2ad35-befb-4da7-9200-86d073085435","order_by":1,"name":"David Cyubahiro","email":"","orcid":"","institution":"Africa Health Sciences University Rwanda","correspondingAuthor":false,"prefix":"","firstName":"David","middleName":"","lastName":"Cyubahiro","suffix":""}],"badges":[],"createdAt":"2026-03-29 16:09:53","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9260012/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9260012/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":108950536,"identity":"700d09d1-de85-4e29-baf7-27f30287b630","added_by":"auto","created_at":"2026-05-11 07:06:08","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":209748,"visible":true,"origin":"","legend":"\u003cp\u003eBlood workup results of our patient\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-9260012/v1/7a269188e6338ce78ce593e6.png"},{"id":108950537,"identity":"e49e6f72-f9f5-4c6b-8b0b-960f5e67399e","added_by":"auto","created_at":"2026-05-11 07:06:08","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":123233,"visible":true,"origin":"","legend":"\u003cp\u003eplain erect abdominal and chest x-ray of our patient\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-9260012/v1/6101e1016a62f64cfde0327a.png"},{"id":108950538,"identity":"c6f4ce79-45f7-4eff-a790-d1b9a2460ca9","added_by":"auto","created_at":"2026-05-11 07:06:08","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":1242094,"visible":true,"origin":"","legend":"\u003cp\u003eintra-op finding of necrotic/gangrenous anterior and posterior stomach wall\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-9260012/v1/ed9d1badc1d4f7d97416bb5d.png"},{"id":108950539,"identity":"fd1d4d75-811d-488f-8d81-5fcb2ae67238","added_by":"auto","created_at":"2026-05-11 07:06:08","extension":"jpg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":26582,"visible":true,"origin":"","legend":"\u003cp\u003e\u0026nbsp;intra-op antral gastric mass (blue arrow)\u003c/p\u003e","description":"","filename":"4.jpg","url":"https://assets-eu.researchsquare.com/files/rs-9260012/v1/46fb9f6f03090e908745d72e.jpg"},{"id":108977980,"identity":"c1a49343-ca18-40ec-b41a-4c9a0728d64f","added_by":"auto","created_at":"2026-05-11 11:33:36","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2277550,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9260012/v1/a4e7075b-b6df-4517-9234-1ae64151115b.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"TITLE: Double Pathology in a Fragile Stomach: Caustic Gastric Perforation with Coexisting Tumor in a Low-Resource Setting","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eGastric perforation is a very common surgical pathology which is a full thickness injury to the stomach wall that creates an abnormal communication between the stomach and peritoneal cavity. This causes the spillage of gastric content into an environment where they are not usually welcomed causing peritonitis in those affected. A recent multicenter study done in the United States revealed the main causes to be peptic ulcer disease, trauma, iatrogenic and about 30% being secondary to malignancy [1].\u003c/p\u003e \u003cp\u003eIngestion of acidic or alkaline corrosive agents poses a major problem in public health and more so in developing countries. Health conditions, mental issues like suicide and economic difficulties are among some of the reasons postulated that cause people to ingest these substances. Caustic injury to the gastrointestinal tract occurs commonly in children with accidental ingestions amounting to 80% of cases seen worldwide [2]. Zargar classification is an endoscopic classification used to grade the degree of mural involvement with grade V representing perforation. Acidic corrosive agents are the main culprits in the developed world while alkaline are the majority of cases in the developing world like India and Rwanda, however these agents rarely cause gastric perforation in those affected [2]. Sati et al described a rare case of caustic induced necrosis in Doha [3]. Cases of caustic gastric perforations are largely underreported in sub-Saharan Africa. A 2025 descriptive cross-sectional study spanning almost 7 years in a teaching hospital in Ouagadougou reported a hospitalization rate of caustic injury to be 1.8% with 33 cases out of 1796 identified and the stomach being the most affected portion of the digestive tract [4]. Only 1 case of perforation (Zargar class V) was identified in this study. There is no reported case of this pathology in Rwanda, talk less of it co-existing with gastric tumor.\u003c/p\u003e"},{"header":"CASE","content":"\u003cp\u003eOur patient is a 57-year-old farmer from a rural catchment area in the Eastern Province of Rwanda, with no known chronic disease or relevant past surgical history who presented to the emergency department of Kibungo level 2 Teaching Hospital with complaints of abdominal distension, multiple episodes of vomiting, obstipation and sudden onset of excruciating abdominal pain prominent at the epigastric region of 3 days duration. She reported significant weight loss, recurrent epigastric pain of over 1 month duration for which she patronized traditional healers and was given herbal concoction. She consumed an estimate of about 500mls of the herbal mixture daily over the period of 1 month till 3 days prior to her presentation. She denied smoking tobacco or consumption of alcoholic beverages.\u003c/p\u003e \u003cp\u003ePhysical examination at arrival revealed a conscious, moderately dehydrated, lethargic and cachectic middle age woman with unrecordably low blood pressure, tachycardia of 120 beats per min (bpm), oxygen saturation of 88% in room air and a temperature of 36C. Abdominal examination was remarkable for a grossly distended abdomen which was tensed with rebound tenderness, hyper-resonant percussion note and absent bowel sounds. Digital rectal exam revealed small quantity of soft stool with an unremarkable vaginal examination.\u003c/p\u003e \u003cp\u003eOur initial clinical impression was that of Septic shock on peritonitis secondary to possible gastric perforation. 2 wide-bore (G-18) cannulas were placed with blood drawn up for investigations, IV antibiotics (ceftriaxone and metronidazole) and paracetamol were administered. Fluid resuscitation with Ringer\u0026rsquo;s Lactate 1 liter commenced immediately. A plain erect abdominal x-ray was ordered for preliminary radiologic guidance.\u003c/p\u003e \u003cp\u003eBlood workup revealed a significantly raised liver function assay of ALT AND AST of 446 and 392U/L respectively, hypokalemia at 2.86mmol/L, urea and creatinine were within normal and Full blood count parameters were all within normal range. Plain abdominal x-ray revealed significant air under both hemi-diaphragms with rectal gas absence. Patient was wheeled to the theatre for an emergency exploratory laparotomy.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eIntra-operative findings were that of multiple areas of gangrene and necrotic gastric tissue on the anterior and posterior surface of the stomach with a large gastric defect of about 10cm on the anterior stomach wall with dark colored gastric content containing food particles like green leafy vegetables. A palpable prepyloric mass could also be felt measuring about 2x 3cm with no adherence to nearby structures. Intra-operatively the patient was persistently hypotensive despite use of vasopressors (noradrenaline). Prompt discussion with the anesthesia team about the possibility of the patient sustaining a demanding gastrectomy and anastomosis was initiated. Considering the poor clinical picture, damage control was opted for with 2 intestinal clamps used to closely the large defect after washout with about 3 liters of normal saline and single layer closure of abdominal wall for possible relook in 24-48hours if the patients clinical state improves. No tissue was taken for histopathology studies as there were no histopathology services in our hospital. There was also no available intensive care unit so patient was kept in the theater recovery room for the entire post-operative period.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003ePost-operatively patient was placed on antibiotics, IV fluids, IV esomeprazole, analgesics and vasopressors. Hemodynamic status didn\u0026rsquo;t improve. Attempts were made to transfer the patient to a higher center with an ICU to no avail. The clinical psychologist was invited to counsel the patient and relatives about the poor prognosis of her condition. About 36 hours post-op the patient succumbed to her illness and was declared clinically dead with probable cause being septic shock with multiorgan failure.\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eCaustic ingestion be it accidental or intentional is a common presentation in most emergency departments of hospitals in Rwanda across all age groups particularly among adolescents and young adults for various socioeconomic and emotional reasons. Our patient had recurrent epigastric pain, post-prandial vomiting and weight loss. These symptoms signal a possible gastric pathology and, in this case, probably symptoms in keeping with a gastric tumor. Commonly for socioeconomic reasons patients with patronize traditional healers with unknown herbal concoctions with varying pH handed to them as their only way out. Delayed presentation might be attributed to poverty, illiteracy, poor health education and trust in the traditional doctors. With repeated high-volume ingestion of the herbal mixture and exposure of the stomach wall to unknown offending agents this might have culminated to the rare and surprising intra-operative findings. Lack of adequate health infrastructure like histopathology services impacted diagnosis, lack of ICU made it difficult to offer adequate management despite the prognosis of the patient.\u003c/p\u003e \u003cp\u003eThis case highlights the dual occurrence of a rare pathology and a common pathologic precedence of gastric perforation, diagnostic and management gaps in a resource-anemic setting signifying that early presentation, high index of suspicion and timely surgical intervention are critical for handling such cases.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eCo-existence of a gastric tumor and caustic gastric perforation is extremely rare. For clinicians practicing in resource constraint settings, a thorough and detailed history, sound clinical examination and maintaining a high index of clinical suspicion in setting of patients presenting with recurrent epigastric pain and history of intake of unknown substances prior to presentation is required to identify and possibly manage these cases.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003e\u003cu\u003eCONSENT TO PARTCIPATE\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors \u003cstrong\u003eobtained Informed consent from the patient and caregivers for the surgical procedure and to write this case report while\u003c/strong\u003e keeping privacy and confidentiality. \u0026nbsp;Attached to supplementary materials and related files.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cu\u003eCONSENT TO PUBLISH\u0026nbsp;\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors \u003cstrong\u003eobtained Informed consent from the patient and caregivers for the publication of this case report while\u003c/strong\u003e keeping privacy and confidentiality. It is attached to supplementary materials and related files. All the authors also approved and consented to the publication of this work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cu\u003eFUNDING DECLARATION\u0026nbsp;\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors received \u003cstrong\u003eNO FINANCIAL SUPPORT\u003c/strong\u003e for the research, authorship and/or publication of this article. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cu\u003eAUTHORS CONTRIBUTIONS\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBoth authors jointly wrote the entire paper with the corresponding author (Shu Bonu) writing the abstract, case and discussion. The second author (David Cyubahiro) wrote the introduction part of the discussion and conclusion.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cu\u003eCLINICAL TRIAL NUMBER\u003c/u\u003e\u003c/strong\u003e; NOT APPLICABLE\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cu\u003eETHICS DECLARATION\u003c/u\u003e\u003c/strong\u003e; NOT APPLICABLE\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cu\u003eACKNOWLEDGEMENTS\u0026nbsp;\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNOT APPLICABLE\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cu\u003eAUTHORS INFORMATION\u0026nbsp;\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eShu BONU and David Cyubahiro are second-year General Surgery residents at the African Health Science University Rwanda currently serving in Kibungo levl 2 Teaching Hospital in the Eastern Province of Rwanda.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eNational Center for Biotechnology Information. Caustic ingestions. In: StatPearls. StatPearls Publishing; 2023. Available from: \u003cu\u003ehttps://www.ncbi.nlm.nih.gov/books/NBK519554/\u003c/u\u003e\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eContini S, Scarpignato C. Caustic injury of the upper gastrointestinal tract: a comprehensive review. World J Gastroenterol. 2013;19(25):3918\u0026ndash;3930. doi: 10.3748/wjg.v19.i25.3918\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eSati WO, Abdow M, Sabir DM, Elhassan H, Salem W. Acute gastric necrosis induced by caustic substance ingestion: a case report. Cureus. 2024;16(11):e74719. doi: 10.7759/cureus.74719\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eSanne ZS, et al. Management of caustic ingestion and its complications in a low-resource setting. Open J Gastroenterol. 2025;15(4):117\u0026ndash;125. doi: 10.4236/ojgas.2025.154010\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bsur","sideBox":"Learn more about [BMC Surgery](http://bmcsurg.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bsur/default.aspx","title":"BMC Surgery","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Obstipation, caustic injury, gastric perforation, gastric tumor, low resource setting.","lastPublishedDoi":"10.21203/rs.3.rs-9260012/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9260012/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eA 57-year-old female with no relevant past medical and surgical history presenting with abdominal distention, epigastric pain and post-prandial vomiting. She was in septic shock at arrival. She was found to have a rare co-existence of a gastric tumor and caustic gastric perforation intra-operatively. Management with damage control surgery and medical management protocols in a severely resource-constraint rural hospital, but sadly didn\u0026rsquo;t survive. This article highlights the rarity of the occurrence of caustic gastric perforation in the setting of a possibly already existing gastric tumor.\u003c/p\u003e","manuscriptTitle":"TITLE: Double Pathology in a Fragile Stomach: Caustic Gastric Perforation with Coexisting Tumor in a Low-Resource Setting","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-05-11 07:06:04","doi":"10.21203/rs.3.rs-9260012/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-05-10T18:22:20+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"227763344530472779958967417508098959697","date":"2026-05-10T18:13:36+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"15377918704437504542726531776311715660","date":"2026-05-10T13:10:13+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-28T14:18:29+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-04-08T13:23:05+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-04-06T07:49:33+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-04-06T07:49:29+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Surgery","date":"2026-03-29T15:51:44+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bsur","sideBox":"Learn more about [BMC Surgery](http://bmcsurg.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bsur/default.aspx","title":"BMC Surgery","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f0d82a9b-8071-4137-b726-54a74eab2215","owner":[],"postedDate":"May 11th, 2026","published":true,"recentEditorialEvents":[{"type":"editorInvitedReview","content":"","date":"2026-05-10T18:22:20+00:00","index":55,"fulltext":""},{"type":"reviewerAgreed","content":"227763344530472779958967417508098959697","date":"2026-05-10T18:13:36+00:00","index":54,"fulltext":""},{"type":"reviewerAgreed","content":"15377918704437504542726531776311715660","date":"2026-05-10T13:10:13+00:00","index":53,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-11T07:06:04+00:00","versionOfRecord":[],"versionCreatedAt":"2026-05-11 07:06:04","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9260012","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9260012","identity":"rs-9260012","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}