Acute gastric dilatation (AGD) is a serious medical condition characterized by the rapid and severe distension of the stomach. This occurs due to an abnormal accumulation of gas, fluid, or food material within the stomach. The condition requires immediate medical attention due to its potential for severe consequences if not promptly addressed.
Understanding the Causes
Several factors can contribute to acute gastric dilatation, ranging from mechanical obstructions to functional issues affecting stomach motility. Mechanical obstructions, such as pyloric stenosis, can prevent the stomach from emptying its contents into the small intestine. Post-surgical strictures or adhesions can also create physical blockages.
Gastric volvulus, a twisting of the stomach, is another mechanical cause that obstructs outflow and can compromise blood flow. Superior mesenteric artery syndrome, where the superior mesenteric artery compresses the duodenum, can also lead to an inability of the stomach to empty.
Functional issues can also play a role, even without a physical blockage. Rapid overeating or overdrinking can overwhelm the stomach’s capacity, especially when combined with excessive air swallowing (aerophagia). Post-surgical complications, particularly after abdominal procedures, can lead to ileus, a temporary lack of normal muscle contractions in the intestines, hindering gastric emptying.
Neurological disorders affecting gastric motility, such as gastroparesis, can impair the stomach’s ability to move food along. Certain medications or electrolyte imbalances may also disrupt normal stomach function. Acute hyperglycemia, seen in conditions like diabetic ketoacidosis, can predispose individuals to AGD by affecting gastric emptying.
Recognizing the Symptoms
Acute gastric dilatation presents with a range of distressing symptoms. Severe abdominal pain is common, often poorly localized but progressive. Patients experience rapid abdominal distension, where the abdomen appears visibly swollen.
Nausea is often present, accompanied by unproductive retching or vomiting. This vomiting may not provide relief, which is characteristic of AGD. The increasing pressure within the stomach can also lead to shortness of breath due to the diaphragm being pushed upwards.
Signs of shock can develop as the condition progresses. These include a rapid heart rate, low blood pressure, and pallor (an unusually pale skin appearance). Patients may also report an inability to pass gas or have a bowel movement.
Diagnosis and Medical Intervention
Diagnosing acute gastric dilatation begins with a physical examination, where professionals assess for pronounced abdominal distension and tenderness. The presence of a succussion splash, a sloshing sound heard over the stomach, can indicate significant fluid and gas.
Imaging studies confirm the diagnosis. Plain film X-rays of the abdomen can reveal an enlarged stomach filled with gas or fluid. Computerized tomography (CT) scans offer more detailed images, helping to visualize the distended stomach and potentially identify any underlying mechanical obstructions.
Laboratory tests may be conducted to assess for electrolyte imbalances that can arise from fluid shifts and to check for signs of shock, such as elevated lactate levels. An upper endoscopy, where a thin, flexible tube with a camera is inserted, can help determine the cause of obstruction and check for ischemic changes in the stomach lining.
Immediate medical intervention is a priority in managing AGD, with the primary goal of relieving pressure within the stomach. Gastric decompression is achieved by inserting a nasogastric tube through the nose into the stomach. This tube allows for the suctioning of trapped air, gastric secretions, and food material, significantly reducing distension and pressure.
Intravenous fluid resuscitation is administered to combat shock and correct any fluid or electrolyte imbalances caused by the condition. Addressing the underlying cause is also a focus of treatment; for example, if a medication is contributing, it may be adjusted or discontinued. In severe cases, particularly when mechanical obstruction or gastric necrosis (tissue death) is suspected, emergency surgery may be required to correct the problem or remove damaged tissue.
Outlook and Preventive Measures
The outlook for acute gastric dilatation largely depends on the promptness of diagnosis and treatment. While it is a rare and potentially life-threatening condition, early recognition and immediate medical intervention improve outcomes. Delays in treatment can lead to severe complications, including gastric necrosis, stomach perforation, and multi-organ failure, which can be fatal.
Preventive measures focus on reducing the risk, especially for individuals with predisposing factors. Avoiding rapid and excessively large meals is advisable, as overconsumption can overwhelm the stomach’s capacity. For individuals with eating disorders or those prone to aerophagia, addressing these behaviors through appropriate medical or psychological support can be beneficial.
Managing underlying medical conditions, such as diabetes or gastroparesis, through medication and lifestyle adjustments can help prevent AGD. For patients undergoing surgery, careful post-surgical care, including a gradual reintroduction of oral intake, helps prevent the stomach from distending too quickly. Adhering to medical advice and recognizing early signs of stomach discomfort can help mitigate the risk of this serious condition.