Distensión gástrica aguda causada por síndrome de arteria mesentérica superior en una paciente bulímica

La dilatación gástrica aguda se fundamenta por dos teorías, la mecánica que es explicada por el síndrome de arteria mesentérica superior, y la atónica que es producto de una condición médica en la que el estómago progresivamente se vuelve hipotónico y se sobredistiende aún en ausencia de una causa mecánica obstructiva; con mayor frecuencia la dilatación gástrica aguda se presenta en pacientes con trastornos de la alimentación y puede conllevar a una complicación rara pero letal como la perforación gástrica. Presentamos el caso de una paciente de 18 años, quien acude al servicio de emergencia con dolor abdominal agudo, es intervenida quirúrgicamente, donde se encontró perforación de la pared gástrica anterior. Se le realizó una gastrectomía parcial proximal, y se envió el espécimen para estudio patológico. La histopatología mostró necrosis transmural predominantemente en fondo gástrico.

Acute gastric dilation is based on two theories, the mechanical one that is explained by the superior mesenteric artery syndrome and the atonic one, the latter is the product of a medical condition in which the stomach progressively becomes hypotonic and over-distended even in the absence of an obstructive mechanical cause; it most often occurs in patients with eating disorders; which can lead to a rare but fatal complication such as gastric perforation. We present the case of an 18 year old patient who comes to the emergency service of our hospital with acute abdominal pain, undergoes surgery, where there is perforation of the anterior gastric wall, and a proximal. Partial gastrectomy is performed, and a sends the specimen for pathology study. Histopathology shows transmural necrosis predominantly in the gastric fundus.

Repeated gastric dilatations leading to fatal abdominal compartment syndrome in a patient with bulimia nervosa

Cases of repeated acute gastric dilatations after binge eating in one patient are rarely reported. We report here a case of repeated acute gastric dilatations in a 22-year-old woman with bulimia nervosa. Her repeated acute gastric dilatations seem to have been related to superior mesenteric artery syndrome. On her last visit due to acute gastric dilatation, she underwent emergency gastric decompression surgery because of abdominal compartment syndrome; however, she eventually died because of ischemia reperfusion injury. Emergency physicians should be aware of the need to manage acute gastric dilatation in patients with eating disorder and should pay attention to the signs and distinctive clinical features of abdominal compartment syndrome.

Resistance to rupture of the equine stomach / Resistência à ruptura do estômago equino

Equine colic is an important and common cause of disease and death in horses. Gastric rupture has been extensively described in the literature, and is known to affect expressive numbers of horses. Gastric dilatation, which precedes rupture, may be observed when the animal consumes large amounts of recently harvested grass or drinks water too fast, though diagnosis criteria also include infestation with Gastherophilus and the presence of ileus and distal intestinal obstructions. The objective of the present study was to determine the resistance to rupture of the equine stomach to air (mm Hg) and water (L) injection. Forty stomachs of young horses (20 geldings and 20 mares) with no defined breed were analyzed. Total organ length (cm), weight (g), greater curved length (cm), lesser curved length (cm) and height (cm) were measured, with no statistical difference between males and females (p > .05). However, stomachs of horses were larger than those of mares and therefore presented higher volumetric capacity (p<0.05). No difference between males and females was observed in the pressure assay (93mmg Hg). Rupture occurred along the greater curvature (99%) and on the visceral (80%) and diaphragmatic (20%) surfaces, across all layers of the gastric wall. Although the equine stomach is relatively small, the organ is considerably resistant to rupture, whether by injection of air or liquid. Horses and mares exhibit similar resistance values, although the stomach of females has smaller volumetric capacity.(AU)

A cólica é um dos problemas mais comuns na clínica de equinos sendo responsável por grande número de mortes. A ruptura gástrica tem sido amplamente descrita na literatura e acomete número expressivo de animais. A dilatação gástrica, que antecede a ruptura, pode advir do consumo excessivo de capim recém-cortado, ingestão rápida de água, infestação por Gastherophilus, ocorrência de íleo paralítico e obstruções intestinais distais. A ruptura gástrica tem sido amplamente descrita na literatura e acomete um número expressivo de animais. Este estudo objetivou determinar a resistência à ruptura do estômago equino mediante a insuflação de ar atmosférico (mmHg) e do preenchimento com água (L). Foram utilizados 40 estômagos de equinos adultos jovens (20 machos castrados e 20 fêmeas) sem raça definida. Medidas relativas ao comprimento total do órgão (cm), peso do órgão (g), curvatura maior (cm), curvatura menor (cm) e altura (cm) foram aferidas e não diferiram entre machos e fêmeas (p>0,05). No entanto, os estômagos dos machos apresentaram medidas superiores as das fêmeas e por assim serem, comportaram um maior volume de água (p<0,05). No teste de resistência mediante insuflação de ar atmosférico não houve diferença entre machos e fêmeas (93mmHg). Os rompimentos ocorreram ao longo da curvatura maior (99%) nas faces visceral (80%) e diafragmática (20%) e abrangeram todas as camadas da parede gástrica. Apesar de ser um órgão relativamente pequeno, o estômago dos equinos apresenta considerável resistência à ruptura, seja por líquido ou por ar atmosférico. Machos e fêmeas possuem resistência gástrica semelhante, embora o estômago das fêmeas equinas comporte um menor volume.(AU)

Síndrome de Wilkie / Wilkie Syndrome

El síndrome de Wilkie o síndrome de la arteria mesentérica superior, es una entidad patológica poco frecuente. Descrito inicialmente por Von Rokitansky en 1861 y apoyado luego por Willet, en 1868. Se caracteriza por una compresión extrínseca de la tercera porción del duodeno por la arteria mesentérica superior y la aorta, ante la reducción del ángulo aortomesentérico. Se presenta el caso de un paciente masculino de 36 años de edad, sin patologías médicas previas, con un cuadro crónico de pérdida de peso, vómitos y sensación de plenitud gástrica. Consultó a valoración en el Servicio de Cirugía, tras realizarse gastroscopía que revelaba una estrechez extrínseca distal al píloro gástrico. Se efectuaron estudios complementarios radiográficos, los cuales revelaron la disminución del ángulo entre la arteria aorta y la arteria mesentérica superior. Posteriormente se realizó un abordaje laparoscópico con anastomosis duodeno yeyunal latero-lateral, con corrección del cuadro patológico y evolución favorable del paciente.

Superior mesenteric artery (SMA) syndrome (Wilkie syndrome) is an uncommon condition. It was first described in 1861 by Von Rokitansky and then reviewed by Willet in 1868. The syndrome develops when the third part of the duodenum is obstructed by the angle formed between the Aortic Artery and the Superior Mesenteric Artery. A 36-year-old male, with no previous medical conditions, with chronic weight loss, vomiting and epigastric pain. The patient was assessed by the Surgery Department after a gastric endoscopy revealed an extrinsic obstruction of the duodenum. After several radiological studies, a reduction of the Aortic and Superior Mesenteric Artery angle was found. A laparoscopic duodenum-yeyunum anastomosis was performed, the medical condition was solved and the patient evolved positively.

Volumetría del remanente gástrico poscirugía de manga gástrica / Post-Sleeve Gastric Pouch Volumetry

La cirugía bariátrica, en sus diferentes modalidades, es una técnica empleada cada vez más en el manejo de los pacientes con obesidad. La cirugía de manga gástrica es una técnica restrictiva utilizada ampliamente y que presenta buenos resultados; sin embargo, al igual que cualquier otro procedimiento, no está exento de complicaciones. En este artículo se indica una manera precisa de evaluar el volumen del remanente gástrico, ya que el incremento de este posterior a la cirugía de manga gástrica es una de las principales causas por las cuales no hay pérdida de peso luego este procedimiento.

Bariatric surgery, through its various forms, is a technique which is increasingly used in the management of patients with obesity. The gastric sleeve is a widely used restrictive technique and it has good results, however, like any other procedure is not exempt of complications. This paper discusses an accurate measurement of gastric pouch, since its increased size is a major cause of absence of weight loss after this procedure.

Delayed Pneumoperitoneum and Acute Pulmonary Edema Secondary to Acute Gastric Dilatation

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.

Atresia de píloro: comunicación de 3 casos / Pyloric atresia: a report of 3 cases

La atresia de píloro es una malformación digestiva infrecuente. La ecografía prenatal mostrará polihidramnios y dilatación gástrica fetal. En el 20% de los casos, la atresia de píloro se asocia con epidermólisis bullosa, una anomalía cutáneo-mucosa de alta morbimortalidad. En la ecografía prenatal, se podrá ver el signo de los "copos de nieve" en el líquido amniótico y alteraciones auriculares en el feto. Por biopsia corial, se determinan mutaciones genéticas asociadas con epidermólisis bullosa, que confirman la asociación y permiten asesorar a los padres portadores. La herencia es autosómica recesiva y 25% de los hijos pueden manifestarla. El recién nacido con atresia de píloro tendrá vómitos no biliosos y la radiografía abdominal mostrará dilatación gástrica y ausencia de aire intestinal. La atresia de píloro es una malformación corregible quirúrgicamente, con buen resultado. Se presentan tres neonatos con atresia pilórica.

Pyloric atresia is a rare malformation of the alimentary tract. Fetal gastric dilatation and polihydramnios are the main prenatal sonographic findings. In 20% of the cases epidermolysis bullosa is associated. This is a group of genetic anomalies affecting the skin and mucous membranes, which appear fragile and easily blistering. Therefore, this association should be investigated as soon as pyloric atresia is prenatally suspected. The "snow flake" sonographic sign in the amniotic fluid and some irregularities in the fetal's ears could be found and should motivate the investigation of those gene mutations known to be related to epidermolysis bullosa, in order to accomplish an appropriate familial counseling. The parents would be carriers of certain mutation and 25% of the siblings will be affected. A newborn with pyloric atresia will soon exhibit non-bilious vomiting and distention of the upper abdomen. A huge gastric dilatation and a gasless intestine will be apparent in the abdominal plain x-ray. Pyloric atresia is a surgically resolvable malformation. We present herein three patients with this infrequent anomaly.

Gastric distention-related neurons in dorsal nucleus of the vagus nerve of rats in response to different acupuncture acupoints / 中国组织工程研究

BACKGROUND:Preliminary studies of our research group mainly focus on the role of nucleus of solitary tract in gastric noxious stimulation and acupuncture point, while dorsal nucleus of vagus nerve, nucleus of solitary tract and area postrema are the necessary component for vagus nerve complex, and dorsal nucleus of vagus nerve plays a crucial role in the regulation of gastric functions. OBJECTIVE:To observe the effect of acupuncture at Zusanli, Neiguan, Pishu and Shenshu acupoints on the gastric-related neurons in dorsal motor nucleus of the vagus nerve. METHODS:The gastric related neurons in dorsal motor nucleus of the vagus nerve of gastric distension rats were identified using extracellular recording technique, according to neuroelectrophysiology method. Acupuncture stimulation was given to Zusanli, Neiguan, Pishu and Shenshu for 15 seconds. The effect of body stimulation on the gastric distension related neurons in dorsal motor nucleus of the vagus nerve of rats was recorded. RESULTS AND CONCLUSION:Among the involved 24 rats, 90 neurons at paraventricular hypothalamic necleus exhibited discharge. Among the discharged neurons, 54 neurons were related to gastric distension. After acupuncture stimulation at Zusanli, Neiguan, Pishu and Shenshu, there were 44, 39, 38, 27 neurons giving a response, the reaction rate was 82%, 72%, 70%and 50%, respectively. Acupunture at different nerve segment acupoints can activate the dorsal motor nucleus of the vagus nerve to different degrees, which is involved in the regulation of gastric motility.

Response of gastric-related neurons in the hypothalamic paraventricular nucleus to acupuncture at Neiguan and Zusanli in a rat model of gastric distension / 中国组织工程研究

BACKGROUND:Previous studies concerning neuromechanism of acupuncture for regulating gastric function mainly focused on peripheral nerve, involving in central nervous system. In particular, there are few studies addressing higher central nervous system. OBJECTIVE:To explore the effects of acupuncture at Neiguan (PC6) and Zusanli (ST36) on gastric-related neurons in the hypothalamic paraventricular nucleus. METHODS:Using microelectrode extracellular recording technique, gastric related neurons in the paraventricular nucleus were found in gastric distension rats. Stimulation was conducted for 30 seconds by hand acupuncture at Neiguan and Zusanli. The effects of acupuncture on gastric-related neurons in the paraventricular nucleus were observed. RESULTS AND CONCLUSION:The discharge of 109 neurons in the hypothalamic paraventricular nucleus of 60 rats was recorded. A total of 56 gastric-related neurons of the 109 neurons were observed. The number of neurons response to acupunctures at Zusanli, Neiguan, Pishu (BL20) and Weishu (BL21) were respectively 44, 47, 29, and 33, with the reaction proportion of 78.57%, 83.47%, 51.79%and 58.93%. Results suggested that there exist gastric distension stimulation and acupuncture stimulations from neurons soma to visceral reaction in the hypothalamic paraventricular nucleus, which simultaneously participates in the regulation of acupuncture on the gastric function.

Superior Mesenteric Artery Syndrome with Massive Gastric Dilatation

Superior mesenteric artery (SMA) syndrome is a rare disorder characterized by extrinsic compression of the third portion of the duodenum between the superior mesenteric artery and aorta, resulting in intermittent obstruction, thereby resulting in proximal duodenal and stomach dilatation. Although the most characteristic symptoms are postprandial epigastric pain, fullness, voluminous vomiting, and eructation, severe symptoms including acute massive gastric dilatation to the extent of surgical abdomen was rarely reported. We report a case of SMA syndrome in a 24-year-old patient with an eating disorder. CT and an upper gastointestinal contrast series revealed massive gastric dilatation which induced vascular compressions. Endoscopy showed deep extensive ulcerations of the whole stomach with duodenal necrosis and ischemia, which prompted immediate surgical laparotomy, but no remarkable intra-abdominal peritonitis evidence was noted. We treated the patient conservatively and the patient recovered from all the symptoms.

Gastric Emphysema Related with Superior Mesenteric Artery Syndrome / 이화의대지

Gastric emphysema is caused by a mucosal disruption of stomach, which is leading to the dissection of air into the wall. A 24-year-old man admitted to our hospital with vomiting, abdominal distension, and pain. Abdominal computed tomography showed severe gastric distension, air within the gastric wall, and a compressed third segment of the duodenum by superior mesenteric artery (SMA). The upper endoscopy revealed multiple geographic ulcers in the gastric body and marked dilatation of the second segment of duodenum and a collapsed third segment. Based on these findings and his symptoms, the patient was diagnosed as having gastric emphysema related with SMA syndrome. He improved after the nasogastric decompression, jejunal feeding and administration of antibiotics. We report a rare case of gastric emphysema related with SMA syndrome. He was managed successfully with medical treatment and nutritional support.

A Case of Gastric Emphysema Associated with Superior Mesenteric Artery Syndrome

We introduce a rare case of gastric emphysema. A 68-year-old man presented with vomiting and dyspnea. Simple abdominal X-ray and CT showed marked dilatation of the stomach and abnormal intramural gas consistent with gastric emphysema. We performed gastric decompression via nasogastric tube drainage and parenteral nutritional support. Nine days after admission, the abnormal intramural gas had disappeared on follow-up CT. The acute gastric dilatation in this patient may have resulted from gastric hypomotility as a result of diabetic gastroparesis in addition to superior mesenteric artery syndrome resulting from malnutrition.

A Case of Gastric Emphysema in Anorexia Nervosa Presenting as Acute Gastric Distension / 대한소화기학회지

Gas within the gastric wall is an alarming finding and a rare condition. Clinically, this condition is divided into two entities; Gastric emphysema and emphysematous gastritis. These two diseases should be differentiated because they are characterized by different clinical symptoms, possible etiology, treatment and prognosis. While emphysematous gastritis is a severe condition with high mortality, gastric emphysema is asymptomatic and usually has benign course. Rarely, anorexia nervosa and bulimia nervosa have been discribed to be associated with acute gastric distension and duodenal obstruction induced by superior mesentery artery syndrome. So, gastric emphysema could be accompanied by acute gastric distension induced by anorexia nervosa. We report a rare case of gastric emphysema in a patient with anorexia nervosa presenting as superior mesenteric artery syndrome with relevant literatures. In this case, the gastric emphysema was improved without surgical intervention after nasogastric tube for decompression and feeding insertion in the fourth portion of the duodenum.

Gastric Necrosis after Gastric Dilatation in a Patient with Bulimia / 대한법의학회지

Acute gastric dilatation leading to gastric necrosis is rare but potentially fatal condition that can occur in patients with bulimia. It usually develops after a bulimic episode and it is not diagnosed with sufficient rapidity it may lead to gastric perforation followed by peritonitis, sepsis, shock, and death. Because of the rarity of this condition and the patients in whom it occurs, the clinician must maintain a high degree of suspicion when treating patients with eating disorders who present with abdominal pain after a binge. This case report describes a 24-year old woman with acute gastric dilatation due to binge eating, who had the gastrotomy and died of complications such as gastric necrosis and disseminated intravascular coagulation.

Tricobezoar gástrico gigante: relato de caso e revisão da literatura / Giant gastric trichobezoar: a case report and literature review

Os autores descrevem um caso de massa abdominal epigástrica palpável associada a sintomas dispépticos em uma paciente jovem sem antecedentes patológicos. Estudos por imagem evidenciaram corpo estranho gástrico de "aspecto enovelado". A paciente foi submetida a gastrotomia via laparotomia, com retirada de um tricobezoar de 1.950 gramas.

The authors describe the case of a palpable epigastric mass associated with dyspeptic symptoms in a young female patient with no previous pathologic history. Imaging studies demonstrated the presence of a gastric foreign body with an "entangled appearance". The patient underwent laparotomy and gastrotomy for removal of a trichobezoar weighing 1,950 grams.

Acute Gastric Dilatation and Calculous Cholecystitis in Duchenne's Muscular Dystrophy

With Duchenne's muscular dystrophy, there are many descriptions from the view of skeletal muscle disorders. However, the functional impairment of smooth muscle can cause fatal problems. A case of a 13-year-old boy, with Duchenne's muscular dystrophy, who present with severe abdominal pain from acute gastric dilatation and acute calculous cholecystitis, is reported. The case is discussed, with a review of the literature.

Gasric Rupture as the Result of a Binge-Eating after a Abstinence Prayer

Spontaneous gastric rupture is a very rare disease and may be related to the consumption of large meals. We experienced a rare case of gastric rupture due to binge eating. A 57-year-old woman visited the emergency department with an abdominal distention following binge eating after a two day abstinence prayer. A plain abdominal X-ray showed free air in the subphrenic space and a markedly distended stomach. At laparotomy, the stomach was dilatated and ruptured about 7 cm from the esophagogastric junction to the lesser curvature. A total gastrectomy was done, but at 11 days, the patient expired due to sepsis. Causes of acute gastric dilatation are various and include binge eating. Massive gastric dilatation leads to a decrease in intramural blood flow and gastric infarction. Symptoms of gastric dilatation may be mild, but are progressive. Diagnosis can be made by observing free air or a distended stomach on a simple abdominal X-ray. Treatment should begin with nasogastric decompression and fluid resuscitation. If conservative treatment fails or if gastric infarction or perforation is suspected, surgical intervention is mandatory.

A Case of Diabetic Gastroparesis Presenting as Acute Gastric Dilatation / 대한소화관운동학회지

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.

Gastric sensorimotor function in patients with functional dyspepsia / 中华消化杂志

0.05). Conclusions Gastric hypersensitivity, impaired proximal gastric accommodation and delayed gastric emptying may be important but independent pathophysiological factors of FD. Different pathophysiological factors can coexist in one patient with FD.

Idiopathic Acute Gastric Dilatation with Ischemic Necrosis

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.