Acute gastric dilatation: Difference between revisions
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==Background== | ==Background== <!--T:1--> | ||
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[[File:Anatomytool Muscles of stomach - English.jpg|thumb|Gastric anatomy.]] | [[File:Anatomytool Muscles of stomach - English.jpg|thumb|Gastric anatomy.]] | ||
[[File:Stomach emptying into duodenum.png|thumb|'''Normal''' emptying of the stomach into the duodenum through the pyloric sphincter.]] | [[File:Stomach emptying into duodenum.png|thumb|'''Normal''' emptying of the stomach into the duodenum through the pyloric sphincter.]] | ||
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===Etiologies=== | ===Etiologies=== <!--T:3--> | ||
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*Post-operative complication (Nissen fundoplication) | *Post-operative complication (Nissen fundoplication) | ||
*Occurs after binge eating episodes, typically in those with an eating disorder | *Occurs after binge eating episodes, typically in those with an eating disorder | ||
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===Pathogenesis=== | ===Pathogenesis=== <!--T:5--> | ||
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*Intragastric pressure >20mmHg leads to impaired intramural blood flow and mucosal necrosis | *Intragastric pressure >20mmHg leads to impaired intramural blood flow and mucosal necrosis | ||
*Gastric volumes greater than 4 liters lead to regular mucosal tears | *Gastric volumes greater than 4 liters lead to regular mucosal tears | ||
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==Clinical Features== | ==Clinical Features== <!--T:7--> | ||
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*[[Special:MyLanguage/vomiting|Emesis]] is typical symptom in 90% of cases | *[[Special:MyLanguage/vomiting|Emesis]] is typical symptom in 90% of cases | ||
*Inability to vomit seen in massive distention | *Inability to vomit seen in massive distention | ||
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==Differential Diagnosis== | ==Differential Diagnosis== <!--T:9--> | ||
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==Evaluation== | ==Evaluation== <!--T:10--> | ||
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*Typical work up for abdominal pain | *Typical work up for abdominal pain | ||
*Upright [[Special:MyLanguage/chest x-ray|chest x-ray]] and [[Special:MyLanguage/acute abdominal series|abdominal series]] to assess for free air | *Upright [[Special:MyLanguage/chest x-ray|chest x-ray]] and [[Special:MyLanguage/acute abdominal series|abdominal series]] to assess for free air | ||
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*CT imaging if safe and indicated | *CT imaging if safe and indicated | ||
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[[File:Acutegastricdilation.png|thumb|Large distended stomach consistent with gastric dilation]] | [[File:Acutegastricdilation.png|thumb|Large distended stomach consistent with gastric dilation]] | ||
==Management== | ==Management== <!--T:13--> | ||
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*[[Special:MyLanguage/nasogastric tube|Nasogastric]] or orogastric decompression is first line therapy | *[[Special:MyLanguage/nasogastric tube|Nasogastric]] or orogastric decompression is first line therapy | ||
**Typically a large special tube required which is placed under anesthesiologist supervision in OR | **Typically a large special tube required which is placed under anesthesiologist supervision in OR | ||
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==Disposition== | ==Disposition== <!--T:15--> | ||
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*Patient may require emergent surgical decompression | *Patient may require emergent surgical decompression | ||
*If improvement with non-operative decompression, may require admission for continued monitoring | *If improvement with non-operative decompression, may require admission for continued monitoring | ||
==Complications== | ==Complications== <!--T:17--> | ||
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*[[Special:MyLanguage/ischemic bowel|Bowel necrosis]] with or without perforation | *[[Special:MyLanguage/ischemic bowel|Bowel necrosis]] with or without perforation | ||
*[[Special:MyLanguage/Abdominal compartment syndrome|Abdominal compartment syndrome]] | *[[Special:MyLanguage/Abdominal compartment syndrome|Abdominal compartment syndrome]] | ||
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==See Also== | ==See Also== <!--T:19--> | ||
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*[[Special:MyLanguage/Bariatric surgery complications|Bariatric surgery complications]] | *[[Special:MyLanguage/Bariatric surgery complications|Bariatric surgery complications]] | ||
==External Links== | ==External Links== <!--T:21--> | ||
==References== | ==References== <!--T:22--> | ||
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<references/> | <references/> | ||
#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. | #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. | ||
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#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. | #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. | ||
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[[Category:GI]] | [[Category:GI]] | ||
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Latest revision as of 16:59, 6 January 2026
Background
- Rare event
- Invariable leads to necrosis with or without perforation
- Most commonly a post-operative complication
Etiologies
- Post-operative complication (Nissen fundoplication)
- Occurs after binge eating episodes, typically in those with an eating disorder
- 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
Nausea and vomiting
Critical
Emergent
- Acute radiation syndrome
- Acute gastric dilation
- Adrenal insufficiency
- Appendicitis
- Bowel obstruction/ileus
- Carbon monoxide poisoning
- Cholecystitis
- CNS tumor
- Electrolyte abnormalities
- Elevated ICP
- Gastric outlet obstruction, gastric volvulus
- Hyperemesis gravidarum
- Medication related
- Pancreatitis
- Peritonitis
- Ruptured viscus
- Testicular torsion/ovarian torsion
Nonemergent
- Acute gastroenteritis
- Biliary colic
- Cannabinoid hyperemesis syndrome
- Chemotherapy
- Cyclic vomiting syndrome
- ETOH
- Gastritis
- Gastroenteritis
- Gastroparesis
- Hepatitis
- Labyrinthitis
- Migraine
- Medication related
- Motion sickness
- Narcotic withdrawal
- Thyroid
- Pregnancy
- Peptic ulcer disease
- Renal colic
- UTI
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
Disposition
- Patient may require emergent surgical decompression
- If improvement with non-operative decompression, may require admission for continued monitoring
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%
See Also
External Links
References
- 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.
- 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.
- 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.