Acute gastric dilation

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

Nausea and vomiting

Critical

Emergent

Nonemergent

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
Large distended stomach consistent with gastric dilation

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

Disposition

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

Complications

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.