Necrotic mega-stomach from superior mesenteric artery syndrome.

Superior mesenteric artery (SMA) syndrome is a rare cause of proximal bowel obstruction due to duodenal compression by the SMA. The morbidity and mortality associated with delayed diagnosis and its complications make it an important differential cause for bowel obstruction. We report a case of mega-stomach secondary to SMA syndrome requiring total gastrectomy. An 18-year-old male presented with vomiting, abdominal pain and shock after a buffet. Computed tomography (CT) imaging revealed a grossly distended stomach (113 × 187 × 350mm) and a transition point at the third part of the duodenum, along with pneumatosis and portal venous gas. Emergency gastroscopy showed blood and necrotic mucosa. Laparotomy confirmed full thickness necrosis and the patient underwent a total gastrectomy with Roux-en-Y reconstruction. Postoperatively, he had a brief intensive care stay and recovered without complications. This case underscores the importance of considering SMA syndrome during presentations of acute gastric dilatation.

Learning Curve in Two-Port Laparoscopic Gastropexy Using FlexDex.

OBJECTIVES: Keyhole gastropexy is becoming increasingly popular, and the new development facilitates shorter surgical times. This paper reports on the learning curve in two-port laparoscopic gastropexy using FlexDex in a specialist's hands. FlexDex is a novel tool combining aspects of robotic surgery without requiring an expensive robot theatre setting. METHODS: Cohort of 16 dogs >25 kg and at high risk of gastric volvulus and dilatation (GDV) undergoing elective laparoscopic gastropexy were enrolled in the study consecutively from 5/2022 to 9/2023. All patients were operated on by one surgeon (FM), and surgical time was recorded to assess learning curve. Competence was defined as plateauing surgical time. Detailed follow-up at 1 day, 7 days, 14 days, 2 months, 6 months, and long-term was recorded for success rate and complications. Ultrasound examination was scheduled at 4-6-month review to confirm lasting success of the gastropexy. RESULTS: All 16 patients were operated on successfully without any significant complications, as confirmed on the ultrasound. The surgical time of laparoscopic gastropexy reduced from 52 to 14 min (reduction of 38 min/73%) and reached plateau after the 12th case of the 16, making it a very steep learning curve in specialist hands. There were no serious complications, and success rate was 100% at the 6-month ultrasound assessment. CLINICAL SIGNIFICANCE: This is the first paper to report on the learning curve with the FlexDex device in a two-port laparoscopic gastropexy setting. It effectively halves the operating time to 30 min, making the surgery safer for the patient and more cost-efficient, without compromising the result.

Acute Gastric Ischemia in a Case of Small Bowel Obstruction.

Gastric ischemia is a relatively rare condition that can lead to severe or life-threatening outcomes. It can be caused by various etiological factors, including vascular occlusion, atherosclerosis, vasculitis, hypovolemic shock, cardiac failure, mesenteric ischemia, splanchnic vasoconstriction, and abdominal compartment syndrome. Furthermore, gastric dilation can be caused by volvulus and acute necrotizing gastritis. This condition may go unnoticed in the setting of intestinal obstruction. In this case report, we describe a 43-year-old female who presented with signs, symptoms, and radiological findings indicative of small bowel obstruction accompanied by a severely dilated stomach. Our aim is to highlight the importance of considering gastric ischemia in patients with small bowel obstruction and to demonstrate the outcomes of a surgical approach in such presentations.

Acute gastric dilatation with segmented abdominal paresis as a rare manifestation of herpes zoster: a case report and review of the literature.

BACKGROUND: Herpes zoster is a common disease that can affect men and women at any age. Sensory neuropathy is the most common complication while motor neuropathy of the abdominal muscles is rare complication appearing in ~ 0.7% of patients. Furthermore, visceral nerve involvement causing gastroparesis is an extremely rare postherpetic complication. We present an extremely rare case of acute gastric dilatation with segmented abdominal paresis as a rare manifestation of herpes zoster infection. CASE PRESENTATION: A 91-year-old Asian man was admitted to hospital with 2-day history of vomiting and left abdominal protrusion. He was previously treated for a rash on the left abdominal wall as herpes zoster infection with oral valaciclovir 2 weeks prior. On physical examination, characteristic herpes zoster rash scars and an ipsilateral abdominal bulge were observed on the left side. Computed tomography revealed no abdominal wall defect, mass, or stenosis. Remarkable distension of the stomach, asymmetrical left flank wall bulge, and a thinner abdominal wall on the left compared with the right side were shown. He was diagnosed as acute gastric dilatation owing to gastroparesis and segmental paresis of the abdominal musculature associated with herpes zoster infection. The patient showed significant improvement in symptoms and abdominal paresis within a month of conservative treatment, including nasogastric tube decompression and mosapride administration. CONCLUSION: Acute gastric dilatation with abdominal paresis is an extremely rare complication of herpes zoster infection, and to date there have been no reports in the literature. It alerts us that, when examining patients with abdominal bulge, we should be conscious of this rare pathology for the optical diagnosis, avoiding unnecessary invasive examination or surgical exploration.

Urothelial carcinoma masquerading as retroperitoneal fibrosis: A case report.

Retroperitoneal fibrosis, a rare and often idiopathic condition, poses significant diagnostic challenges. While most cases are considered idiopathic or immune-mediated, a small but important proportion are associated with malignant neoplasms, with implications for prognosis and management. The present study describes the case of a 69-year-old man who presented to the emergency department of the Virgen de las Nieves University Hospital (Granada, Spain), with a 2-week history of epigastric pain, vomiting and altered bowel habits. Laboratory investigations revealed previously undiagnosed renal insufficiency. An abdominal computed tomography (CT) scan showed extensive diffuse retroperitoneal infiltration extending from the periduodenal region to the pubic bone, resulting in gastric dilatation and hydronephrosis. A CT-guided retroperitoneal biopsy was performed and pathology confirmed the presence of urothelial carcinoma. This diagnosis led to the initiation of a chemotherapy regimen consisting of carboplatin and gemcitabine specifically designed for urothelial carcinoma. A follow-up 18F-FDG PET scan performed 6 months later showed a partial functional response. This case illustrates a rare presentation of urothelial carcinoma masked by extensive retroperitoneal fibrosis, and highlights the importance of accurate diagnosis in reducing tumor burden and improving the clinical status of patients.

Association of mesenteric volvulus in police working dogs with and without a prior prophylactic laparoscopic gastropexy.

OBJECTIVE: To evaluate the association of mesenteric volvulus (MV) in New York Police Department police working dogs (PWDs) with and without a prior prophylactic laparoscopic gastropexy (PLG). ANIMALS: 370 PWDs (82 with and 288 without PLG). METHODS: Medical records and surgery and radiology reports were reviewed from 2012 to 2022. Signalment, pertinent history (medical and surgical), gastropexy status, temperament, and training type were recorded. Statistical analysis was used to identify the relationship between prophylactic gastropexy and MV within the patient population. RESULTS: 3 cases of mesenteric volvulus were noted in this patient population. Two (2.4%) of the 82 PWDs that had undergone prophylactic laparoscopic gastropexy developed MV, whereas 1 (0.3%) of the 288 PWDs that had not undergone a gastropexy procedure developed MV. Police working dogs with PLG were estimated to be at 7.2 times greater odds of MV (point estimate OR, 7.18; 95% CI, 0.642 to 80.143); however, the low incidence of MV in this population limited statistical power, and thus this effect did not achieve statistical significance. Evaluation of MV incidence in additional populations of working dogs will allow greater precision in the point estimate. CLINICAL RELEVANCE: Prophylactic gastropexy may be associated with an increased risk for MV. However, patients without prophylactic gastropexy are at risk for gastric dilatation and volvulus, which is more common than MV. Therefore, the authors continue to recommend prophylactic gastropexy to decrease the risk for gastric dilatation and volvulus.

Clostridium ventriculi in a cynomolgus monkey with acute gastric dilatation and rupture: A case report.

Acute gastric dilatation (AGD) is one of the most prevalent and life-threatening diseases in nonhuman primates worldwide. However, the etiology of this syndrome has not been determined. Recently, sudden death occurred in a 7-year-old female cynomolgus monkey with a history of fecal microbiota transplantation using diarrheic stools. The monkey had undergone surgery previously. On necropsy, gastric dilatation and rupture demonstrated a tetrad arrangement on histopathologic examination. On 16S rRNA sequencing, a high population of Clostridium ventriculi was identified in the duodenum adjacent to stomach but not in the colon. This paper is the first report of Clostridium ventriculi infection in a cynomolgus macaque with acute gastric dilatation and rupture.

Retching Without Vomiting With Acute Abdominal Distension: A Clinical Cue.

Gastric volvulus leading to acute gastric dilatation is a rare presentation of congenital diaphragmatic hernia. Urgent detorsion with gastropexy and closure of the diaphragmatic defect are essential to prevent further complications and recurrence. We present a rare case of an infant with acute gastric dilatation due to acute gastric volvulus secondary to congenital diaphragmatic hernia.

Can we predict the development of acute gastric dilatation in patients with anorexia nervosa?

BACKGROUND: Acute gastric dilatation can develop in patients with anorexia nervosa who are being refed to achieve weight restoration. If unrecognized, this condition is associated with significant morbidity and mortality. Patients with acute gastric dilatation usually have abdominal pain, nausea, and vomiting. Abdominal imaging confirms the diagnosis. This study aims to identify risk factors associated with the development of acute gastric dilatation in patients with severe restrictive eating disorders in order to hasten diagnosis and guide treatment. This study also aims to define the clinical outcomes of patients with acute gastric dilatation. METHODS: In this retrospective case series, 15 patients with a restrictive eating disorder were studied. Multiple variables were assessed for significant correlation with stomach size. RESULTS: 15 patients with a restrictive eating disorder were identified as being diagnosed with acute gastric dilatation through chart review during the study period. The average dilated stomach size was 20.5 cm. There was no significant correlation of stomach size with any of the following: % ideal body weight on day of admission, % ideal body weight on day of imaging study, rate of weight gain (kg per week), or duration of illness. Serum levels of sodium, potassium, phosphorus, magnesium, calcium, bicarbonate, blood urea nitrogen, glucose, albumin, and hematocrit on the day of imaging, did not correlate with stomach size. All patients were treated with conservative management. None of the patients required surgical intervention or progressed to gastric necrosis or perforation, and there were no recurrences of the acute gastric dilatation. CONCLUSIONS: There are no specific risk factors significantly associated with the development of acute gastric dilatation in patients with severe restrictive eating disorders. Clinicians should maintain a high index of suspicion for this condition when patients are experiencing abdominal pain, nausea, or vomiting. When promptly diagnosed and treated, outcomes are good. If diagnosis is delayed, the outcome can be dire.

The mainstay of treatment of patients with severe restrictive eating disorders is initiation of nutrition to gain weight. One potential complication when patients are started on nutrition is the development of a massively enlarged stomach, also called acute gastric dilatation. If a patient's care provider does not recognize the development of acute gastric dilatation, it can lead to serious problems, including death. Patients with this condition usually have abdominal pain, nausea, and vomiting. These are common symptoms in patients with anorexia nervosa and are often dismissed. Identifying risk factors associated with developing acute gastric dilatation could help providers recognize this condition and promptly start treatment. This study sought to identify risk factors associated with developing acute gastric dilatation in patients with severe restrictive eating disorders. Several variables, including patient age, duration of illness, body mass index, %ideal body weight, laboratory values, medications, type of nutrition, and rate of weight gain were analyzed. This study found that there are no specific risk factors significantly associated with development of acute gastric dilatation in patients with severe restrictive eating disorders being initiated on nutrition. Therefore, providers need to listen to their patients, evaluate symptoms, and have a high index of suspicion for underlying acute gastric dilatation.

Gastric Pneumatosis and Its Gastrofibroscopic Findings in Life-Threatening Superior Mesenteric Artery Syndrome Complicated by Anorexia Nervosa in a Child.

A 14-year-old girl was admitted to the emergency department for excessive bile-containing vomiting and severe abdominal pain. She had been healthy until she intentionally lost 25 kg over a 6-month period. Thick, bloody bile-mixed food particles were drained from the stomach through a nasogastric tube. Abdominal computed tomography revealed huge stomach dilatation with extensive gastric pneumatosis, possible near rupture, acute pancreatitis, and a very narrow third of the duodenum, indicating superior mesenteric syndrome. Gastrofibroscopy revealed multiple hemorrhagic ulcers and numerous bead-like cystic lesions in the stomach. Laboratory examination results were notable for severe deficiencies in critical nutrients, including iron, zinc, proteins, and prealbumin, as well as undernutrition-associated endocrine complications such as hypothyroidism and hypogonadotropic hypogonadism. Excessive vomiting ceased after the endoscopic removal of stagnant gastric contents. Gastric pneumatosis improved after 3 days of supportive care.

Gastric Dilatation Masquerading as Anterolateral ST-Elevation Myocardial Infarction.

A variety of noncardiac conditions mimic the electrocardiographic changes of ST-elevation myocardial infarction (STEMI). Therefore, a physician must maintain a high index of suspicion when evaluating ST-segment elevation (STE). We present a case of epigastric pain secondary to ileus and gastric dilatation masquerading as anterolateral STEMI on an electrocardiogram (ECG). The STE promptly resolved following laparotomy. To the best of our knowledge, this is the first case of anterolateral STE secondary to gastric dilatation.

Acute Gastric Dilatation With Ischemia and Perforation Requiring Emergency Total Gastrectomy: A Case of Suspected Abdominal Compartment Syndrome.

Acute gastric dilatation is an uncommon surgical pathology, leading to gastric ischemia, necrosis, perforation, sepsis, and death if untreated. While rare, the development of abdominal compartment syndrome is also a devastating complication of this entity. We present a case of a 42-year-old male with a history of gastric volvulus, presenting with severe acute abdominal distension and multi-organ failure. A diagnosis of acute gastric dilatation was made, with suspicion of abdominal compartment syndrome. Emergency laparotomy was performed when nasogastric decompression failed. Total gastrectomy without anastomosis was performed due to the patient's hemodynamic instability. However, he demised shortly after on the operating table. This case report demonstrates that even with rapid diagnosis and management, acute gastric dilatation continues to be associated with high mortality.

A healthy young patient with hepatic portal vein gas due to acute gastric dilatation: a case report.

Hepatic portal vein gas (HPVG) is caused by the influx of gastrointestinal gas into the intrahepatic portal vein as a result of gastrointestinal wall fragility due to ischemia or necrosis. Gastrointestinal tract necrosis is fatal in severe cases. We observed a case of food intake-induced acute gastric dilatation (AGD) in a healthy young male who developed HPVG and underwent conservative treatment. A 25-year-old male presented to our hospital with epigastric pain and nausea the day after excessive food intake. Computed tomography (CT) revealed gas along the intrahepatic portal vein and marked gastric dilatation with large food residue. AGD-induced HPVG was considered. Esophagogastroduodenoscopy (EGD) was not performed at this stage because of the risk of HPVG and AGD exacerbation, and the patient was followed up with intragastric decompression via a nasogastric tube. Food residue and approximately 2 L of liquid without blood were vomited 1 h after the nasogastric tube placement. His symptoms improved after the vomiting episode. An EGD was performed 2 days after undergoing CT. Endoscopic findings revealed extensive erosions and the presence of a whitish coat extending from the fornix to the lower body of the stomach, indicating AGD. HPVG disappeared on the CT scan taken during EGD. Thereafter, symptom relapse and HPVG recurrence were not observed.

Localized skin mottling associated with acute gastric dilatation.

We present a case of a 55-year-old woman complaining of abdominal distension owing to acute gastric dilatation. Her localized skin mottling had spread from the lower abdomen to both knees. The skin mottling in the area affected by gastric dilatation improved immediately after stomach emptying using a gastric tube and upper endoscopy.

Binge eating after a religious fast: Acute gastric dilation causing perforation - a case report.

Acute gastric dilation after binge eating may lead to ischaemic necrosis and perforation of the gastric wall. Though rarely seen owing to the rich blood supply of the stomach, its sequelae may be avoided by prompt decompression of the dilated stomach. We present such a case heretofore rarely reported from India.

Acute Gastric Dilatation Complicated by Necrosis and Perforation Following a Binge Eating Episode.

Acute gastric dilatation is a rare entity limited to case reports in the literature. It is characterized by significant distention of the stomach beyond physiologic parameters. The sequelae of this phenomenon are life-threating, as it can lead to gastric perforation. It is frequently reported in patients who suffer from eating disorders, particularly binge eating disorder and bulimia nervosa. We present a case of a 28-year-old female who suffered from acute gastric dilatation following significant food intake. Her long hospital course was complicated by gastric necrosis and perforation, requiring multiple laparotomies prior to the restoration of a functional gastrointestinal tract. We aim to demonstrate the true gravity of this diagnosis and raise its awareness.