Acute gastric dilatation can have multiple etiologies which may lead to ischemia of the stomach. Without proper timely diagnosis and treatment, potentially fatal events such as gastric perforation, haemorrhage, and other serious complications can occur. Here we present a 36-year-old man who came to the casualty with pain abdomen and distension for 2 days. Clinically, abdomen was asymmetrically distended more in the left hypochondrium and epigastrium region. Straight X-ray abdomen showed opacified left hypochondrium with nonspecific gaseous distension of bowel. Exploratory laparotomy revealed dilated stomach with patchy gangrene over lesser curvature and fundic area. About 4 litres of brownish fluid along with semisolid undigested food particles was sucked out (mainly undigested pieces of meat). Limited resection of gangrenous areas and primary repair were done along with feeding jejunostomy. Necrosis of the stomach was confirmed on histopathology. The patient recovered well and was discharged on the tenth postoperative day.
Acute gastric dilatation can have multiple etiologies which may lead to ischemia of the stomach. The etiologies are lifestyle habits, underlying morbidities, acute necrotizing inflammation, acute vascular insufficiency, and postoperative complications. Without proper timely diagnosis and treatment, potentially fatal events such as gastric perforation, haemorrhage, and other serious complications can occur. We here present a rare case of gastric dilatation leading to patchy gangrenes on the surface of stomach and how timely intervention was carried out.
A 36-year-old male patient, referred from periphery hospital with nasogastric tube in place, presented to the casualty with pain abdomen and abdominal distension for two days which was not relieved with conservative treatment. Two days ago he had taken nonvegetarian meal twice, in increased quantity than usual, within a short gap of 3 hours between those two meals. Then he had two episodes of vomiting 6 hours later. His past history was not significant. He was not suffering from any psychiatric illness or any co-morbidity like diabetes and had not undergone any surgeries. His vital parameters were within normal limits. Abdominal examination showed more asymmetrical distension in left hypochondrium and epigastrium with tympanicity all over the abdomen without signs of peritonitis. Straight X-ray abdomen showed opacified left hypochondrium with nonspecific gaseous distension of bowel (Figure
X-ray chest and abdomen showing opacification in the left hypochondrium.
Gangrenous area on lesser curvature with dilated stomach.
Gangrenous area on the fundus of the stomach.
Perforation in lesser curvature gangrenous area after handling of that area.
Nasogastric tube tip visible after sucking of semisolid thick brown contents.
Resection of gangrenous area till fresh bleeding occurs.
Primary closure of the defect by suturing using 2-0 vicryl.
Feeding jejunostomy done.
In 1833, Duplay first described acute gastric dilatation [
Ischemia is caused presumably due to venous insufficiency when massive dilatation occurs [
Several theories have been postulated to explain the pathogenesis of acute gastric dilatation. Morris et al. claimed that anaesthesia and debilitation may be predisposing factor as it is a very frequent postoperative complication. Relaxation of the upper oesophageal sphincter with aerophagia may be a factor leading to gastric distention [
In more than 90% of cases of acute gastric dilatation, vomiting is an important and common symptom [
Plain abdominal films and CT scan can demonstrate gastric distension and free air and are useful in the diagnosis. In our case, since the distension was increasing and huge, we just planned to explore the patient with just abdominal X-ray showing opacification in left hpochondrium with gaseous distension of bowel. Treatment focuses on early diagnosis and decompression of the stomach, thus halting the vascular congestion and thus ischemia [
The authors declare that there is no conflict of interests regarding the publication of this paper.