https://wikem.org/w/index.php?action=history&feed=atom&title=Acute_gastric_dilatation%2FenAcute gastric dilatation/en - Revision history2026-04-19T11:16:38ZRevision history for this page on the wikiMediaWiki 1.38.2https://wikem.org/w/index.php?title=Acute_gastric_dilatation/en&diff=379521&oldid=prevFuzzyBot: Updating to match new version of source page2026-01-06T17:13:40Z<p>Updating to match new version of source page</p>
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==Background==<br />
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[[File:Anatomytool Muscles of stomach - English.jpg|thumb|Gastric anatomy.]]<br />
[[File:Stomach emptying into duodenum.png|thumb|'''Normal''' emptying of the stomach into the duodenum through the pyloric sphincter.]]<br />
*Rare event<br />
*Invariable leads to necrosis with or without perforation <br />
*Most commonly a post-operative complication<br />
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===Etiologies===<br />
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*Post-operative complication (Nissen fundoplication)<br />
*Occurs after binge eating episodes, typically in those with an eating disorder<br />
**[[Special:MyLanguage/Bulimia nervosa|Bulimia nervosa]] <br />
**Also psychogenic polyphagia<br />
*Mechanical obstruction<br />
**[[Special:MyLanguage/Pyloric stenosis|Pyloric stenosis]]<br />
**Stricture/adhesions<br />
**[[Special:MyLanguage/SMA syndrome|SMA syndrome]]<br />
**[[Special:MyLanguage/Gastric volvulus|Gastric volvulus]]<br />
*Other etiologies including [[Special:MyLanguage/Diabetes mellitus|Diabetes mellitus]], [[Special:MyLanguage/trauma|trauma]], spinal conditions<br />
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===Pathogenesis===<br />
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*Intragastric pressure >20mmHg leads to impaired intramural blood flow and mucosal necrosis<br />
*Gastric volumes greater than 4 liters lead to regular mucosal tears<br />
*Patients with pathologic eating disorders can have larger gastric volumes at baseline<br />
*Acute massive gastric dilation is an extreme form (intragastric pressure >30)<br />
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==Clinical Features==<br />
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*[[Special:MyLanguage/vomiting|Emesis]] is typical symptom in 90% of cases<br />
*Inability to vomit seen in massive distention<br />
*Other features include: <br />
**Abdominal distention<br />
**[[Special:MyLanguage/Abdominal pain|Abdominal pain]]<br />
**Signs of [[Special:MyLanguage/peritonitis|peritonitis]] after perforation<br />
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==Differential Diagnosis==<br />
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{{Nausea and vomiting DDX}}<br />
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==Evaluation==<br />
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*Typical work up for abdominal pain<br />
*Upright [[Special:MyLanguage/chest x-ray|chest x-ray]] and [[Special:MyLanguage/acute abdominal series|abdominal series]] to assess for free air<br />
**Can identify large distended stomach on x-ray <br />
*CT imaging if safe and indicated<br />
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[[File:Acutegastricdilation.png|thumb|Large distended stomach consistent with gastric dilation]]<br />
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==Management==<br />
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*[[Special:MyLanguage/nasogastric tube|Nasogastric]] or orogastric decompression is first line therapy <br />
**Typically a large special tube required which is placed under anesthesiologist supervision in OR<br />
*Resuscitation with fluids and intravenous antibiotics as indicated<br />
*If conservative measures fail or gastric infarction suspected, surgical intervention mandatory<br />
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==Disposition==<br />
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*Patient may require emergent surgical decompression <br />
*If improvement with non-operative decompression, may require admission for continued monitoring<br />
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==Complications==<br />
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*[[Special:MyLanguage/ischemic bowel|Bowel necrosis]] with or without perforation<br />
*[[Special:MyLanguage/Abdominal compartment syndrome|Abdominal compartment syndrome]]<br />
*[[Special:MyLanguage/Sepsis|Sepsis]]/[[Special:MyLanguage/Septic shock|Septic shock]]<br />
*If gastric necrosis and/or perforation not recognized and treatment delayed, mortality reaches 80%<br />
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==See Also==<br />
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*[[Special:MyLanguage/Bariatric surgery complications|Bariatric surgery complications]]<br />
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==External Links==<br />
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==References==<br />
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<references/><br />
#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. <br />
#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. <br />
#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.<br />
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[[Category:GI]]</div>FuzzyBot