Acute gastric dilatation: Difference between revisions
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==Etiologies== | ==Etiologies== | ||
*Occurs after binge eating episodes, typically in those with an eating disorder | *Occurs after binge eating episodes, typically in those with an eating disorder | ||
*[[ | *Psychogenic [[polyphagia]] | ||
*Other etiologies including [[Diabetes mellitus]], trauma, [[gastric volvulus]], gastric outlet obstruction [[[pyloric stenosis, [[SMA syndrome]], spinal conditions | *Other etiologies including [[Diabetes mellitus]], trauma, [[gastric volvulus]], gastric outlet obstruction [[[pyloric stenosis, [[SMA syndrome]], spinal conditions | ||
Revision as of 01:44, 8 January 2017
Background
- Rare event
- Invariable leads to necrosis with or without perforation
- Most commonly a post-operative complication
Etiologies
- Occurs after binge eating episodes, typically in those with an eating disorder
- Psychogenic polyphagia
- Other etiologies including Diabetes mellitus, trauma, gastric volvulus, gastric outlet obstruction [[[pyloric stenosis, SMA syndrome, spinal conditions
Pathogenesis
- Intragastric pressure >20mmHg leads to impaired intramural blood flow and mucosal necrosis
- Gastric volumes greater than 4 liters lead to regular mucosal tears
- Patients with pathologic eating disorders can have larger gastric volumes at baseline
- Acute massive gastric dilation is an extreme form (intragastric pressure >30)
Clinical Features
- Emesis is typical symptom in 90% of cases
- Inability to vomit seen in massive distention
- Other features include:
- Abdominal distention
- Abdominal pain
- Signs of peritonitis after perforation
Differential Diagnosis
Evaluation
- Typical work up for patient with abdominal pain
- Upright chest x-ray and abdominal series to assess for free air
- Can identify large distended stomach on x-ray
- CT imaging if safe and indicated
Management
- Nasogastric or orogastric decompression first line
- Typically a large special tube under anesthesiologist supervision in OR needs to be placed
- Resuscitation with fluids and intravenous antibiotics as indicated
- If conservative measures fail or gastric infarction suspected, surgical intervention mandatory
- If gastric necrosis or perforation not recognized and treatment delayed, mortality reaches 80%