An unusual case of massive gastric distension with catastrophic sequelae

Abstract

We report a case of massive gastric distension presenting with abdominal pain, shock and lower limb ischaemia. At laparotomy, gastric distension was found to be secondary to gastric outflow obstruction compounded by gas formation from antacid ingestion. Both the aorta and inferior vena cava were directly compressed by the distended stomach. This mode of presentation and combined aetiologies remain unreported. Gastric decompression resulted in profound cardiovascular compromise, multiorgan failure and eventually death.

The effect of gastric dilatation in rats submitted to gasified water ingestion under the hepatic metabolic function

“…Among these hamstrings are the hepatic gastric, gastrosplenic, gastrocolic, gastrophrenic, and the fix retroperitoneal portion of the duodenum that maintains the gastric position in caudal direction [9][10][11][12][13][14][15][16] . When the integrity of the ligament support system of the stomach is compromised in its superior portion, the movement of the larger curvature in the cranium direction will result into an organoaxial gastric volvulus, "stomach turned down", while the flabbiness of the fix retroperitoneal portion of the duodenum will provoke mesenteroaxial gastric volvulus 10,11,17 . In laparotomized animals that ingested gasified water, gastric dilatation of fundic predominance observed, which consequently can provoke tension and flabbiness of the cranium gastric ligaments.…”

“…Its compressive action on the esplenic vessels, caudal caval vein and portal system, as the derivation system through the azygos vein is not sufficient to compensate the reduction of the venous return. This congestion thus will provoke esplenic vascular complications, renal, posterior and hepatic muscles, provoking the portal hypertension [11][12][13][14][15][16][17] . It is known that the gas accumulation in the stomach of dogs in progressive manners in experimental conditions elevates the pressure until 80mmHg and reduces the oxygen tension in 92% having its effects causing isquemic lesions of the organ mucous, especially in the large curvature of the bottom and gastric body 17 .…”

“…This congestion thus will provoke esplenic vascular complications, renal, posterior and hepatic muscles, provoking the portal hypertension [11][12][13][14][15][16][17] . It is known that the gas accumulation in the stomach of dogs in progressive manners in experimental conditions elevates the pressure until 80mmHg and reduces the oxygen tension in 92% having its effects causing isquemic lesions of the organ mucous, especially in the large curvature of the bottom and gastric body 17 . The laboratorial results of the present investigation revealed a significant raise of the pyruvic transaminase, alkaline phosphatase and tendency of increasing the oxaloacetics transaminase, indicating hepatic disfunction.…”

“…The extrinsic vascular congestion and intrinsic gastric ischemia, due to the stomach dilatation, can reduce the system's hepatic endothelial reticulum capacity. This scenery, by itself would narrow the bacteria and eliminates endotoxines that can be absorbed by the mucous gastrointestinal ischemia 17 . A recent study demonstrated that the plasmatic levels of endotoxines were higher in dogs with gastric dilatation due to the bigger intestinal absorption and hepatic intestinal elimination 10,18 .…”

Hypocalcemia in Post Caesarean Patient Presenting as Acute Gastric Dilation

“…[2][3][4][5] Patients following surgery especially under general anesthesia, debilitated patients, acute infections, emotional stress, trauma, cast syndrome, typhoid, pneumonia, progressive muscular dystrophies, diabetes mellitus, electrolyte disturbances, anorexia nervosa and child birth are few noted predisposing factors for AGD. [6] AGD can broadly be classified into obstructive and non-obstructive AGD, obstructive AGD can be caused by obstruction, trauma, and rupture of pulmonary bullae, superior mesenteric artery syndrome, enteric placement of endotracheal tube, and upper endoscopic procedures whereas non-obstructive causes include eating disorders, hemorrhage/trauma resuscitation, medications like mydriatics, electrolyte abnormalities especially potassium and calcium disturbances and infections.…”