Difference between revisions of "Acute gastric dilation"

(Differential Diagnosis)
Line 31: Line 31:
==Differential Diagnosis==
==Differential Diagnosis==
===By organ system===
*See [[Abdominal Pain]]
*See [[Nausea and vomiting]]
**[[Peptic ulcer disease]]
***Strangulated hernia
**[[Cholecystitis]], [[Cholangitis]]
**[[Acute Hepatitis]]
**[[Mesenteric ischemia]]
**Esophageal disorders (e.g. achalasia, GERD, [[esophagitis]])
**Functional disorders such as [[Irritable Bowel Syndrome]]
**[[Cannabinoid hyperemesis syndrome]]
**[[Spontaneous bacterial peritonitis]]
**[[Urinary tract infection]]
**Bacterial toxins, Viruses (adeno, norwalk, rota)
**Heavy metal poisoning
**Methanol poisoning
**[[Diabetic ketoacidosis]]
**Thyroid/parathyroid disorders
**[[Anorexia nervosa]], [[Bulimia nervosa]]

Revision as of 02:11, 8 January 2017


  • Rare event
  • Invariable leads to necrosis with or without perforation
  • Most commonly a post-operative complication



  • 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


  • Typical work up for 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


  • Nasogastric or orogastric decompression is first line therapy
    • Typically a large special tube required which is placed under anesthesiologist supervision in OR
  • 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%


  • Patient may require emergent surgical decompression
  • If improvement with non-operative decompression, may require admission for continued monitoring

See Also

External Links