Difference between revisions of "Acute gastric dilation"

(Created page with "==Background== *Rare event *Invariable leads to necrosis with or without perforation *Most commonly a post-operative complication ==Etiologies== *Occurs after binge eating e...")
 
(Etiologies)
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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]]
+
*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

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%

Disposition

See Also

External Links

References