Spontaneous rupture of the stomach. A rare complication of pyloric stenosis

Abstract

ROYAL VICTORIA INFIRMARY, NEWCASTLE UPON TYNESPONTANEOUS rupture of the stomach is a rare and usually fatal acute abdominal emergency. A recent review of the world literature (Albo, de Lorimier, and Silen, 1963) lists 43 recorded cases and adds I other.Further cases have been described (Olsen and Foley, 1961 ; Shaldon, 1961 ; Foex, 1962). Aetiological factors reported have included aerophagy, excessive intake of sodium bicarbonate, and external trauma.Pyloric stenosis has been present as a predisposing factor i n few of the recorded cases. CASE REPORTMrs. A., aged 45 years, was admitted to the Royal Victoria Infirmary as an emergency at 2.45 a.m. on 6 Nov., 1964, complaining of severe abdominal pain and distension. Her distress was such that she could not give an adequate history of her condition.HISTORY.-The history, obtained in retrospect, was that for 5 years she had suffered episodic epigastric pain, heartburn, and nausea. The pain had been relieved by alkalis. A barium-meal examination in 1961 was normal but a chest radiograph taken at the same time showed partial collapse of the lower lobe of the left lung. This was proved to be associated with bronchiectasis and treatment was given with good effect. She had suffered almost continuous epigastric discomfort and pain for 6 weeks before her admission to hospital and had been vomiting copiously. This pain had not been relieved by alkalis. The vomiting was of the type associated with pyloric stenosis. For 5 days she had eaten only small amounts of invalid and strained baby foods. In the 24 hours immediately preceding admission, she had vomited once, bringing up only a small volume of brown fluid. At 9.0 p.m. on 5 Nov., while sitting in a chair watching television, she developed a severe upper abdominal pain which persisted without relief for 5 hoyrs. At 2.0 a.m. on 6 Nov. it suddenly became 'agonizing .O N EXAMINATION.-The patient was obviously in great pain. She was thin, dehydrated, and appeared to have recently lost weight. Her respiration was rapid and grunting. The abdomen was distended and tympanitic with generalized tenderness and rigidity.Clinical findings were : temperature, 99" F. ; pulse, 130 per min.; blood-pressure, 1zo/80 mm. Hg. The blood picture was: Haemoglobin IOO per cent, P.C.V. 49 per cent, W.B.C. 8200 per c.mm. The blood chemistry gave: urea 54 mg. per IOO ml.; sodium 139 mEq./l.; potassium 3.8; chloride gg mEq./l.; carbon-dioxide content 28 mEq. per IOO ml. Radiographs of the'abdomen (supine and lateral decubitus) showed that: There is considerable gaseous distension of the bowel with hepato-diaphragmatic interposition of the colon. Some intraperitoneal fluid is present and there is the suggestion of free,intraperitoneal gas shown on the lateral decubitus film.A nasogastric tube was passed but no aspirate was obtained. Anintravenous infusionof normal saline was started.Her condition deteriorated at an alarming rate. The abdominal distension increased visibly and the respiratory capacity was correspondingly reduced. Breathing was rapid and ...

Life-threatening gastric dilatation with anorexia nervosa

“…It is mainly caused as a result of "binge eating" if a patient has anorexia nervosa or bulimia. Other cases of gastric dilatation (both with or without perforation of the stomach) have been reported as a result of air swallowing or after Nissen fundoplication [1,2] and also after excessive eating, pylorospasm with threat of peptic ulcer disease [2,3], acute pancreatitis, gastric haemorrhage, injury, pregnancy or ingestion of sodium bicarbonate. Additionally there are cases documenting complications involving gastric infarction with perforation, compression of the aorta with ischemic injury of the bowels and lower arteries [4].…”

An autopsy case of sudden death due to acute gastric dilatation without rupture

“…Severe dilatation of the stomach accompanied by gastric necrosis has been reported in patients who cannot belch or vomit after a Nissen fundoplication and as a complication of pyloric stenosis causing altered gastric emptying [31,32]. Acute gastric dilatation with infarction is recognized complication of trauma [33].…”

Zur Inzidenz von Magen-Rupturen nach Ingestion kohlensäure- bzw. bikarbonathaltiger Getränke

“…Als mo È glicher Grund dafu È r wird ein funktioneller Spasmus der Kardia und/oder des Pylorus erwa Èhnt [3,6,26]. Auch Mukosafalten (die gewissermassen als «Ventil» wirken ko È nnen) [6] oder ein mechanischer Verschluss durch den Druck des u È berbla Èh-ten, direkt neben dem distalen Úsophagus liegenden Magenfundus werden als Erkla Èrungsmodelle angefu È hrt [3,6,9]. Wa È hrend sich der gasgefu È llte Magen ausdehnt, bewegt er sich nach unten u È ber das Duodenum und erzeugt so eine zeitweilige MagenausgangsStenose.…”