Difference between revisions of "Acute gastric dilation"

(Differential Diagnosis)
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*Resuscitation with fluids and intravenous antibiotics as indicated
 
*Resuscitation with fluids and intravenous antibiotics as indicated
 
*If conservative measures fail or gastric infarction suspected, surgical intervention mandatory
 
*If conservative measures fail or gastric infarction suspected, surgical intervention mandatory
*If gastric necrosis or perforation not recognized and treatment delayed, mortality reaches 80%
+
 
 +
==Complications==
 +
*Bowel necrosis with or without perforation
 +
*[[Abdominal compartment syndrome]]
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*[[Sepsis]]/[[Septic shock]]
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*If gastric necrosis and/or perforation not recognized and treatment delayed, mortality reaches 80%
  
 
==Disposition==
 
==Disposition==

Revision as of 02:17, 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 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 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

Complications

Disposition

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

See Also

External Links

References