Acute gastric dilatation is a rare but fatal condition. It is often diagnosed late as physicians may not consider it high in their list of differential diagnosis.
Recently we had this 70 year old female patient who had poorly controlled diabetes, ischemic heart disease and very poor exercise tolerance coming with 3 days history of abdominal distention and abdominal pain. She had low blood pressure with a tachycardia. Abdominal examination revealed a mild tenderness over the upper abdomen. Rest of the abdomen was soft. Inflammatory markers were high, thus treatment of the patient continued in the line of severe sepsis.
Following image shows her supine abdominal X-Ray.
X-ray shows a dilated stomach and first part of the duodenum which was suggestive of an acute gastric dilatation.
Nasogastric (NG) decompression was done and management of sepsis continued. Initial conservative management strategy was opted due to high risk of surgery and anesthesia in this patient.
Other investigations failed to reveal any other focus of infection. Patient had very little chances of survival as she had very high risk for general anesthesia. While patient being prepared for a Contrast Enhanced CT Scan of Abdomen, she passed away due to severe sepsis and septic shock.
Following are few other causes of Acute gastric dilation,
- Binge eating episodes, typically in those with an eating disorders ( Anorexia nervosa, Bulimia nervosa, Psychogenic polyphagia)
- Post-operative complication (Nissen flundoplication, Splenectomy)
- Mechanical obstruction
- Pyloric stenosis
- Stricture/adhesions
- SMA syndrome
- Gastric volvulus
- Trauma
- Spinal injuries and disorders
Even though stomach has a very rich blood supply, in already compromised patients it can lead to necrosis of stomach leading to sepsis. Early diagnosis and timely decompression can avoid surgery and save patient from this potentially fatal condition.
Check out following references,
- Shawn Steen et al, Acute gastric dilation and ischemia secondary to small bowel obstruction, Proc (Bayl Univ Med Cent). 2008 Jan; 21(1): 15–17.
- Sorinel Lunca et al, Acute Massive Gastric Dilatation: Severe Ischemia and Gastric Necrosis without Perforation,Romanian Journal of Gastroenterology September 2005 Vol.14 No.3, 279-283.
- https://wikem.org/wiki/Acute_gastric_dilation
0 Comments