ABSTRACT
Pneumoperitoneum caused by acute gastric dilatation (AGD) is a very rare complication. We report a case of pneumoperitoneum and acute pulmonary edema caused by AGD in a patient with Parkinson's disease. A 78-year-old woman presented with pneumonia and AGD. We inserted a nasogastric tube and administered empirical antibiotics. We performed an endoscopy, and perforation or necrosis of the stomach and pyloric stenosis were not observed. Thirty-six hours after admission, the patient suddenly developed dyspnea and shock, and eventually died. We suspected the cause of death was pneumoperitoneum and acute pulmonary edema caused by AGD during the conservative treatment period. Immunocompromised patients with chronic illness require close observation even if they do not show any symptoms suggestive of complications. Even if the initial endoscopic or abdominal radiologic findings do not show gastric necrosis or perforation, follow-up with endoscopy is essential to recognize complications of AGD early.
Subject(s)
Aged , Female , Humans , Anti-Bacterial Agents , Cause of Death , Chronic Disease , Dyspnea , Endoscopy , Follow-Up Studies , Gastric Dilatation , Immunocompromised Host , Necrosis , Parkinson Disease , Pneumonia , Pneumoperitoneum , Pulmonary Edema , Pyloric Stenosis , Shock , StomachABSTRACT
Diabetic gastroparesis is a pathologic condition of delayed gastric emptying with gastrointestinal symptoms such as nausea, early satiety and vomiting in the absence of mechanical obstruction in patients with diabetes mellitus. We report a case of diabetic gastroparesis who had diabetes mellitus for 13 years and suffered from nausea and vomiting with marked gastric dilatation of acute onset. Blood glucose level of the patient was very high and any mechanical obstruction was not found by gastroduodenal endoscopy, hypotonic duodenography, celiac angiography, electrogastrography and CT scan. Acute gastric dilatation was resolved with conservative treatment of gastric drainage, glucose control and hydration. Gastrointestinal symptoms of nausea and vomiting improved and diet was well tolerated thereafter.
Subject(s)
Humans , Angiography , Blood Glucose , Diabetes Mellitus , Diet , Drainage , Endoscopy , Gastric Dilatation , Gastric Emptying , Gastroparesis , Glucose , Nausea , Tomography, X-Ray Computed , VomitingABSTRACT
Acute gastric dilatation without obstructive or organic disease is rare, but is possible after a gastric or an abdominal operation in cases of trauma, retroperitoneal hematoma, diabetic gastroparesis, hypoxemia, electrolyte imbalance, etc. However ischemic necrosis due to acute gastric dilatation is very rare and has been reported only in patients who has anorexia nervosa or overeat suddenly. If the distended stomach is not decompressed successfully by using a conservative method or if the process proceeds to ischemic necrosis, operative treatment is necessary. We experienced a case in which the stomach was acutely distended, and mutiple ischemic necroses had developed. The patient was a 27-year-old woman and had no specific underlying disease in her medical history. After overeating, the stomach was distended acutely. During the operation, mutiple ischemic necroses were found in the stomach. A total gastrectomy and Roux-en-Y esophagojejunostomy were performed.