Unexpected Findings in Diffuse ST-Segment Depression and aVR ST-Segment Elevation

El Mallouli, Mohamed;El Bakkali, Amina;Azziz, Usama;Massart, Pierre-Emmanuel;Pintea Bentea, Georgiana
(2026) Diagnostics — Vol. 16, n° 9, p. 1300 (2026)

Files

El Mallouli M, Diagnostics, 2026.pdf
  • Open Access
  • Adobe PDF
  • 2.78 MB
Download

Details

Authors
  • El Mallouli, Mohamedorcid-logoCardiology Department, CHU Brugmann, 1020 Brussels, Belgium
    Author
  • El Bakkali, AminaEmergency Department, CHU Brugmann, 1020 Brussels, Belgium
    Author
  • Azziz, UsamaCardiology Department, CHU Brugmann, 1020 Brussels, Belgium
    Author
  • Massart, Pierre-EmmanuelUCLouvain
    Author
  • Pintea Bentea, GeorgianaCardiology Department, CHU Namur Sainte Elisabeth, 5000 Namur, Belgium
    Author
Abstract
Electrocardiographic changes resembling myocardial ischemia are rare in gastrointesti-nal emergencies. In particular, gastric perforation has been reported in association with ST-segment elevation, but not with ST-segment depression mimicking non-ST-segment elevation myocardial infarction (NSTEMI). We report the case of a 60-year-old woman presenting with sudden-onset epigastric pain radiating to the chest. She remained hemo-dynamically stable throughout her emergency department stay. On admission, the ECG showed diffuse ST-segment depression with ST-segment elevation in aVR. High-sensitivity troponin and inflammatory markers were within normal limits. Coronary angiography revealed no significant coronary stenosis, and left ventriculography demonstrated preserved left ventricular systolic function. Abdominal computed tomography showed abundant pneumoperitoneum, diffuse anterior gastric wall thickening, and moderate intraperitoneal fluid, findings highly suggestive of gastric perforation. The patient underwent laparo-scopic gastric repair and abdominal lavage, with an uneventful postoperative recovery. A repeat ECG 24 h after surgery showed complete resolution of the ST-segment abnormalities. To our knowledge, this is the first reported case of gastric perforation presenting with diffuse ST-segment depression and aVR ST-segment elevation. Awareness of this presentation helps to broaden the spectrum of diagnostic possibilities and to plan appropriate diagnostic-therapeutic procedures.
Affiliations

Citations

  • APA
  • Chicago
  • FWB

El Mallouli, M., El Bakkali, A., Azziz, U., Massart, P.-E., & Pintea Bentea, G. (2026). Unexpected Findings in Diffuse ST-Segment Depression and aVR ST-Segment Elevation. Diagnostics, 16(9), 1300. https://doi.org/10.3390/diagnostics16091300 (Original work published 2026)