Acute gastric dilatation: Difference between revisions
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*Other features include: | *Other features include: | ||
**Abdominal distention | **Abdominal distention | ||
**Abdominal pain | **[[Abdominal pain]] | ||
**Signs of peritonitis after perforation | **Signs of [[peritonitis]] after [[perforation]] | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
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
- Occurs after binge eating episodes, typically in those with an eating disorder
- Anorexia nervosa
- Bulimia nervosa
- Also Psychogenic polyphagia
- Mechanical obstruction
- Pyloric stenosis
- Stricture/adhesions
- SMA syndrome
- Gastric volvulus
- Other etiologies including Diabetes mellitus, trauma, 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
- See Abdominal Pain
- See Nausea and vomiting
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
- Bowel necrosis with or without perforation
- Abdominal compartment syndrome
- Sepsis/Septic shock
- If gastric necrosis and/or perforation not recognized and treatment delayed, mortality reaches 80%
Disposition
- Patient may require emergent surgical decompression
- If improvement with non-operative decompression, may require admission for continued monitoring