A study of intragastric and intravesicular pressure changes during rest, coughing, weight lifting, retching, and vomiting

Abstract

Background In patients undergoing a variety of procedures, surgical success is in part dependent on maintaining normal intra-abdominal pressure in the immediate postoperative period. Our objective was to quantify intragastric and intravesicular pressures during activities, through the use of manometry catheters. Methods Ten healthy volunteers had a manometry catheter placed transnasally, and a urinary Foley catheter placed. Baseline intragastric and intravesicular pressures were recorded and the catheters were then transduced continuously. Pressures were recorded with activity: coughing, lifting weights, retching (dry heaving), and vomiting. Results All pressure changes were significant from baseline except for weight lifting. The highest intragastric pressure was 290 mmHg, seen during vomiting. Comparison of intragastric and intravesicular pressures showed no significant difference. There was significantly higher intragastric pressure with vomiting and retching as compared with coughing, whereas coughing applied more pressure than weight lifting. Conclusions This is the first report of intragastric pressures during vomiting and retching (dry heaving). We conclude that vomiting and retching (dry heaving) can render significant forces on any tissue apposition within the stomach or the peritoneal cavity.Keywords Intragastric pressure Á Intravesicular pressure Á Manometry Á VomitingThe measurement and understanding of intra-abdominal pressure in the surgical patient is gaining clinical relevance. For patients with hernias (abdominal, inguinal, and hiatal) surgical success is dependent, in part, upon controlling intraabdominal pressures in the immediate postoperative period. This is also true for patients who undergo fundoplication procedures (both open and laparoscopic) because early postoperative vomiting is known to cause fundoplication disruption and intrathoracic migration [1]. We are currently investigating transoral gastroplasty alternatives and it would be useful to quantify the pressure that a gastroplasty would encounter during activities such as lifting, retching, and vomiting. The measurement of intra-abdominal pressure has become an integral part of the care of the critically injured patient, as excessive intra-abdominal pressures lead to abdominal compartment syndrome with disastrous consequences such as renal failure, hypotension, respiratory compromise, and decreased splanchnic circulation [2].A literature review of intra-abdominal pressure during everyday activities reveals a paucity of information. Determination of such pressures would establish a baseline force that needs to be withstood by abdominal closures, hernia repairs, prosthetic mesh, fundoplications, and a

Potential Precipitating Factors of Esophageal Variceal Bleeding: A Case–Control Study

“…One previous study demonstrated that Valsalva ' s maneuver can lead to elevations in intravariceal pressure ( 5 ). Valsalva maneuver-related activities such as staining on defecation ( 28,29 ), vomiting ( 30,31 ), and cough ( 31 ) are believed to increase intra-abdominal pressure. Although a pathophysiological study showed that increase in intra-abdominal pressure by mechanical compression causes elevations in portal pressure ( 6 ); however, whether these activities lead to EV rupture has never been investigated.…”

Natural orifice transluminal endoscopic surgery gastrotomy closure with an over-the-endoscope clip: a randomized, controlled porcine study (with videos)

“…They are reported to be in the range of 1 to 12 mm Hg at rest in an empty stomach. [34][35][36] Intragastric pressure is increased by 2-to 3-fold in the presence of 300 to 600 mL of gastric fluid. 37 Mean intragastric pressures during coughing, vomiting, retching, and weight lifting have been reported to be 35, 89, 62, and 2 mm Hg, respectively, with corresponding peak pressures of 233, 290, 281, and 52 mm Hg.…”

“…37 Mean intragastric pressures during coughing, vomiting, retching, and weight lifting have been reported to be 35, 89, 62, and 2 mm Hg, respectively, with corresponding peak pressures of 233, 290, 281, and 52 mm Hg. 36,38,39 In human cadavers, 100 to 150 mm Hg is necessary to cause mucosal disruption at the gastric cardia. 39 Therefore, pressurized leak tests have been used to provide objective data about the strength of closures in several studies.…”

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“…Intragastric pressure has been shown to increase with coughing to as high as 233 mmHg (mean = 37 mmHg) and with vomiting to as high as 290 mmHg (mean = 81 mmHg) [39]. Yehoshua et al [40] showed that in sleeve gastrectomy, performed on a 50 Fr bougie and reinforced with absorbable running suture, the mean intrasleeve pressure, filled with saline, was 43 mmHg (range: 32-58 mmHg) and that small additional fluid volumes (150 cm 3 ) result in significant elevation of intraluminal pressure (58 mmHg before fluid refluxed into the esophagus).…”