Acute gastric dilation

Japanese: 急性胃拡張

Concept: A condition in which there is a sudden decrease in tone or paralysis of the stomach wall, and even though there is no organic obstruction, the discharge of gastric contents into the duodenum is prevented, resulting in the accumulation of gastric juices, air, ingested material, etc., causing the entire stomach to become significantly distended.
Pathophysiology: It is said to be most common after upper abdominal surgery, but it can also occur in elderly people with wasting diseases, starvation, peritonitis, abdominal trauma, diabetes, infections, and mental illnesses. Furthermore, gastric distension worsens in the presence of aerophagia or respiratory disorders. Recently, the frequency of postoperative acute gastric distension has decreased due to advances in anesthetics and perioperative management, but on the other hand, cases caused by overeating have been frequently reported.
Clinical symptoms: There are no particular symptoms, but it occurs suddenly. Common symptoms include hiccups, heartburn, and small amounts of vomiting due to stomach distension, which may resemble an attack of angina pectoris.
Examination results showed a marked distention of the upper abdomen, and a plain abdominal X-ray showed an enlarged stomach. Blood tests showed signs of blood concentration due to severe dehydration, as well as decreased levels of Na, Cl, and HCO3, and, combined with the effects of vomiting, showed signs of metabolic alkalosis.
Diagnosis It is presumed based on the medical history and clinical symptoms, and is diagnosed when a plain abdominal X-ray or CT scan reveals a markedly distended stomach filled with gastric contents and air. Differentiation from acute abdominal conditions is important, but peritoneal irritation and muscular defenses are not observed except in cases of gastric perforation or rupture.
Treatment: Fasting and continuous suction of gastric contents are immediately performed. Dehydration is corrected through infusion of fluids, electrolytes are corrected, nutrition is provided, and acid secretion inhibitors and gastrointestinal motility stimulants are administered. If left untreated, perforation or gastric necrosis due to impaired blood flow in the stomach wall can occur, resulting in a poor prognosis, so early diagnosis and early treatment are important. [Kamishige Norio]
■ References
Bochus, HL: Gastroenterology. 4th ed, Vol 2, WB Saunders, Philadelphia, 1985.
Takahiko Nagamine: Schizophrenia and acute gastric dilatation. Japanese Medical News (4209): 30-32, 2004.

Source : Internal Medicine, 10th Edition About Internal Medicine, 10th Edition Information

Japanese:

概念
　急激な胃壁の緊張低下あるいは麻痺が生じ，器質的な閉塞機転がないにもかかわらず，胃内容の十二指腸への排出が障害され，胃液，空気，摂取物などが貯留し胃全体が著明に拡張した状態をいう．
病態生理
　上腹部の手術後に最も多いといわれており，その他，消耗性疾患の高齢者，飢餓，腹膜炎，腹部外傷，糖尿病，感染症，精神疾患などに合併することがある．さらに，空気嚥下症や呼吸障害がある場合には胃拡張は悪化する．最近では，術後の急性胃拡張は麻酔薬や周術期の管理の進歩により発生する頻度は減少しているが，一方では過食による症例がたびたび報告されている．
臨床症状
　これといった特徴的な症状はないが突然に起こる．よく認められるのが胃の拡張に伴うしゃっくり，胸やけ，少量の嘔吐であり，狭心症の発作に類似する場合がある．
検査成績
　上腹部の著明な膨隆を呈し，腹部単純Ｘ線像にて拡張した胃を認める．血液検査では，高度の脱水のため血液の濃縮所見，Na，Cl，HCO3などの低下が認められ，嘔吐の影響も加わって代謝性アルカローシスの所見を示す．
診断
　病歴，臨床症状から推定され，腹部単純撮影，さらにはCTにて胃内容物や空気で著明に拡張した胃が認めることから診断される．急性腹症との鑑別が重要であるが，胃穿孔や胃破裂の場合を除き，腹膜刺激症状や筋性防御を認めない．
治療
　絶食，胃内容の持続的吸引を直ちに行う．輸液による脱水の是正，電解質の補正，栄養補給，酸分泌抑制薬，消化管運動賦活薬の投与を行う．放置すると胃壁の血流障害による穿孔や胃壊死を惹起し，予後不良となるので早期診断，早期治療が重要である．［上西紀夫］
■文献
Bochus, HL : Gastroenterology. 4th ed, Vol 2, WB Saunders, Philadelphia, 1985.
長嶺敬彦：統合失調症と急性胃拡張．日本医事新報 (4209): 30-32, 2004.

出典　内科学第10版内科学第10版について　情報

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