C52-19 Gastric Perforation During a Competitive Eating Event Complicated by Mixed Bacterial-Fungal Peritonitis and Secondary Pleural Space Infection

Introduction Gastric perforation precipitated by competitive eating is exceedingly rare and carries the potential for catastrophic intra-abdominal contamination. Beyond the initial insult, cross-compartment spread of infection from the abdomen into the pleural space represents an unusual but clinically significant complication. Recognition of these mechanisms is essential for timely management of severe postoperative sepsis. Case Presentation A 44-year-old male with neurofibromatosis type I , congenital deafness, obstructive sleep apnea, gastroesophageal reflux disease presented with sudden severe abdominal pain immediately after a pizza-eating competition. Computed tomography (CT) imaging revealed a gastric perforation, and he underwent emergent exploratory laparotomy with primary repair, followed by admission to the intensive care unit.His postoperative course was complicated by a perisplenic abscess and localized peritonitis. Peritoneal cultures grew Klebsiella pneumoniae, Enterobacter cloacae, mixed flora, and Candida lusitaniae, prompting treatment with broad-spectrum antibacterial therapy and high-dose fluconazole. Serial CT imaging demonstrated decreasing intra-abdominal fluid collections.He subsequently developed a loculated left pleural effusion concerning for secondary transdiaphragmatic extension of infection. A chest tube was placed, and he received intrapleural tissue plasminogen activator (tPA) and dornase alfa with radiographic and clinical improvement. Pleural fluid was exudative and grew rare Staphylococcus warneri. The chest tube was removed once drainage and imaging stabilized.His course was also notable for acute anemia requiring multiple transfusions. Esophagogastroduodenoscopy (EGD) revealed a large but healing gastric ulcer without active bleeding. After discharge, outpatient follow-up CT and repeat EGD demonstrated interval improvement in both the gastric ulcer and the perisplenic collection. Discussion This case highlights the rare occurrence of gastric perforation triggered by competitive eating—a mechanism capable of inducing extreme gastric overdistension and rupture. It further illustrates the potential for cross-compartment spread of infection from the abdominal cavity into the pleural space, resulting in loculated effusions requiring drainage and fibrinolytic therapy. Mixed bacterial-fungal peritonitis, including infection with Candida lusitaniae, added significant complexity and necessitated coordinated surgical, thoracic, critical-care, and antimicrobial management. Early recognition of multisystem involvement was critical to achieving clinical stabilization. This abstract is funded by: None