Ver el código de «Acute gastric dilatation»

==Background==
[[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.]]
*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==
*[[vomiting|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 DDX}}

==Evaluation==
*Typical work up for abdominal pain
*Upright [[chest x-ray]] and [[acute abdominal series|abdominal series]] to assess for free air
**Can identify large distended stomach on x-ray 
*CT imaging if safe and indicated

[[File:Acutegastricdilation.png|thumb|Large distended stomach consistent with gastric dilation]]

==Management==
*[[nasogastric tube|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==
*[[ischemic bowel|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==
*[[Bariatric surgery complications]]

==External Links==

==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. 
#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.

[[Category:GI]]