Acute Gastric Dilatation - Causes, Symptoms, and Treatment

Introduction:

Acute gastric dilatation is the abnormal widening of the stomach. It can be caused by many conditions like overeating, anorexia nervosa (a disorder where the person is underweight and does not eat enough for fear of gaining weight), infections, trauma, etc. It is usually found by taking abdominal X-rays and CT (computerized tomography) scans of the abdomen. It presents symptoms like stomach pain, nausea, vomiting, and an enlarged stomach. The patient can pass gas but has constipation for 4 to 5 days. The treatment depends on the underlying cause, and the management is done accordingly.

What Is Acute Gastric Dilatation?

Acute gastric dilatation is a rare and fatal condition if not treated early. Due to the abnormal widening of the stomach with the presence of gastric gas, there is compression of the gastric wall. It causes reduced or no blood supply to the stomach, though the stomach has a rich blood supply. When no blood is supplied, the tissues in the gastric wall (stomach wall) die. It becomes like an obstruction (block), and the digestion is affected, and there is no proper bowel emptying.

What Are the Causes of Acute Gastric Dilatation?

The exact reasons for acute gastric dilation are unclear. However, some theories suggest gastric dilation due to compression of the third part of the duodenum in the middle of the vertebra, aorta, and superior mesenteric artery.

• Ischemia: The stomach has a rich blood supply, but when the intragastric pressure (pressure inside the stomach) is beyond the portal venous pressure (blood vessels that carry blood supply from the gut and its neighboring structures to the liver), the blood supply is compromised. It results in reduced or no blood supply (ischemia), leading to the death of the tissues lining the stomach.

• High Intragastric Pressure: Gastric perforation or holes in the stomach also occurs when the intragastric pressure goes above 120 mmHg (millimeters of mercury) - 150 millimeters of mercury (mmHg). The normal gastric pressure is 9-14 millimeters of mercury (mmHg). The symbol of mercury, a chemical, is Hg.

However, a few conditions mentioned below also cause gastric dilation.

• Overeating: Overeating is when a person overeats beyond feeling full.

• Binge Eating: A person eats a large quantity of food and does not feel like stopping eating.

• Bulimia Nervosa: Bulimia nervosa is an eating disorder where the person consumes large amounts of food and follows certain steps not to gain weight.

• Infections: Helicobacter pylori is a bacteria that causes infections and a few conditions like peptic ulcer (inflammation in the lining of the stomach, small intestine, and esophagus), gastritis (sores in the stomach lining), and cancer in the stomach (abnormal tissue growth in the gut).

• Trauma: Road traffic accidents cause multiple traumas, and the stomach is sometimes compressed due to injury. The compressed stomach has no blood supply leading to the death of tissues lining the stomach.

• Spine Injury: In patients with spinal cord injury, the autonomic nerve innervation of the gastrointestinal tract is deranged. It causes many complications in the gastrointestinal tract leading to intragastric pressure. The autonomic nervous system provides nerve supply to internal organs and blood vessels. It manages certain functions like blood pressure and breathing rate. It functions automatically.

• Post-Operative Complications: Gastric perforations occur in specific post-operative procedures like feeding jejunostomy. Feeding jejunostomy is a surgical procedure where a feeding tube is inserted into the proximal part of the jejunum (a part of the small intestine) through the abdominal skin from the exterior to administer medications.

• Adhesive Ileus: Adhesive ileus results from a series of surgical procedures in the abdomen. Adhesions are scar tissues formed due to repeated surgical procedures and result in tissues and organs sticking together. It leads to obstructions (blockage) in the bowels.

What Are the Symptoms of Acute Gastric Dilatation?

• Pain in the stomach.

• Vomiting.

• Nausea.

• Constipation.

• Abnormal swelling of the belly region.

• Chest pain.

• Respiratory distress (shortness of breath).

What Are the Tests to Find Acute Gastric Dilatation?

• Physical Examination: The doctor feels the abdomen for swelling and checks if the patient feels pain while touching the belly.

• X-Rays of the Abdomen: X-ray is electromagnetic radiation that can penetrate the structures in the body and capture images. The captured images appear in black-and-white areas.

• Computerized Tomography (CT) Scan of the Abdomen: Computerized tomography scan uses high-frequency radio waves to capture organ images in a computer. It captures the targeted organs or structures in detail. The dilation or widening in the stomach is viewed.

• Complete Blood Count: Complete blood count is done to screen blood parameters like red blood cells, white blood cells, platelets, hemoglobin, and neutrophils. Any changes in the normal ranges of these parameters reveal infection or disease.

How Is Acute Gastric Dilatation Treated?

1. Nasogastric Decompression: Nasogastric tube is a thin tube inserted into the nose to reach the stomach and pass through the esophagus. The pressure in the stomach is released due to blockage in the intestine. Nasogastric decompression is also performed in motor vehicle accidents to remove stomach pressure and prevent complications.
2. Fluid Resuscitation: Fluid replacement therapy is followed to replace lost body fluids like blood. The fluids can be administered orally or injected through veins. Fluids usually consist of ringer lactate solution and saline solution. Blood transfusion is also carried out in cases of severe bleeding.
3. Surgical Intervention:

• • Partial Gastrectomy: A part of the stomach is removed surgically.
  • Total Gastrectomy: The whole stomach is surgically removed.
  • Sleeve Gastrectomy: The left side of the stomach is removed surgically.
  • Esophagojejunostomy: A surgical procedure that creates an artificial connection between the esophagus and intestine.
  • Feeding Jejunostomy: A surgical procedure that involves placing a feeding tube in the skin of the abdomen into the proximal part of the jejunum to administer medication or nutrition if the patient cannot take it orally.
  • Total Gastrectomy With Cervical Esophagostomy: Surgical removal of the whole stomach and placement of a feeding tube in the front of the neck. A nasogastric tube placement guides it. The nasogastric tube is removed later, and the lewis feeding tube is placed in position.

What Are the Complications of Acute Gastric Dilatation?

• Gastric Hemorrhage: Bleeding in the gastrointestinal tracts, including the mouth, stomach, and rectum.

• Gastric Perforation: Perforations or holes in the stomach lining.

• Gastric Infarction: Death of tissues lining the stomach occurs due to reduced blood supply.

• Fluid and Electrolyte Imbalance: There is an imbalance in the electrolyte in the body fluids due to fluid loss. Electrolytes like sodium, calcium, potassium, chlorides, and phosphate are lost while vomiting or due to excess sweating. They manage the fluid balance in the body, maintain the blood pH, and play a role in blood clotting and forming new tissues.

• Damage to Other Abdominal Organs: The blood supply to the stomach is compromised in acute gastric dilatation cases. It, in turn, affects the blood supply to other abdominal organs like the liver. It further damages these organs.

• Pulmonary Aspiration: Accidental inhalation of a substance like vomit, liquids, or saliva into the lungs or airways.

• Respiratory Failure: It occurs when the blood has reduced oxygen and contains more carbon dioxide. It fails to exchange gasses (oxygen and carbon dioxide) while breathing.

• Emphysematous Gastritis: It is a rare disease that causes inflammation in the stomach walls, and gas-forming organisms form gas in the stomach wall.

• Paralytic Ileus: When the muscles in the intestine are paralyzed (not in a condition to perform their function), paralytic ileus occurs. The muscles that play a role in transporting food inside the intestine do not function properly due to problems in the functioning of the nerves or muscles.

What Is the Prognosis of Acute Gastric Dilatation?

The prognosis is moderate if the condition is treated early. The prognosis is poor if the condition is treated late and causes the patient's death.

Conclusion:

Acute gastric dilatation is a rare and fatal condition if not treated early. It shows symptoms like abdominal pain, enlarged stomach, nausea, vomiting, and constipation. The condition generally occurs in people who overeat and have disorders like bulimia nervosa or anorexia nervosa (people who do not eat at all due to fear of gaining weight), road traffic accidents, trauma, or post-surgical complications. The condition is highly fatal (causing death) if a preventive procedure like nasogastric decompression is not carried out if acute gastric dilatation is ruled. Surgical procedures involving removing a part or full stomach are choices of treatments. Though the condition is confirmed using imaging techniques, starting the treatment will prevent complications and keep the patient safe and alive.