A completed gastromalacia after brainstem hemorrhage within 24 h: A case report and literature review.

• Gastromalacia has some key diagnostic indicators include a history of gastric ulceration, hyperthermia, and certain neurological disorders, such as traumatic brain injury. • Accurate differential diagnosis is crucial to distinguish gastromalacia from pneumoperitoneum, pneumothorax, and gastric penetration or rupture. • A complete gastromalacia can occur within 24 hours. Gastromalacia is a postmortem feature characterized by rapid autolysis of the stomach, typically leading to a large rupture, predominantly in the gastric fundus. The pathophysiology of gastromalacia remains enigmatic. This study presents a novel case of a 32-year-old male who succumbed to respiratory failure after brainstem hemorrhage after sexual intercourse, which ultimately resulted in complete gastromalacia. Autopsy revealed hyperpyrexia (38.1 °C, 6 h post-mortem) and a substantial laceration (32 mm × 8 mm, irregular margins) in the inferior ventrolateral region of the pons on the right side. Additionally, the occurrence of complete gastromalacia within 24 h challenged our previous understanding that gastromalacia typically presents as a smaller lesion one day after death. Misdiagnosis of gastromalacia can arise from both forensic and clinical practices. This study raised the potential factors contributing to the rapid development of complete gastromalacia within 24 h. Through a literature review, we identified several key diagnostic indicators that may aid in distinguishing this condition, including a history of gastric ulceration, hyperthermia, and certain neurological disorders.