Acute gastric dilation

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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:

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

  • 1.Dewangan M, Khare MK, Mishra S, and Marhual JC. Binge eating leading to acute gastric dilation, ischemic necrosis and rupture. Journal of Clinical and Diagnostic Research." 2016; 10(3): 6-7.
  • 2. Lunca S, Rikkers A, and Stanescu A. Acute massive gastric dilation: Severe ischemia and gastric necrosis without perforation. Romanian Journal of Gastroenterology'. 2005; 14(3): 279-283.
  • 3.Santos T, Freitas C, and Pinto-de-Sousa J. Gastric wall ischemia following massive gastric distention due to pyloric stenosis: a case report. Journal of Surgical Case Reports. 2016; 2: 1-3.