ACG: American College of Gastroenterology Poster - Acute Gastric Dilation
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Poster presentation at the 2013 ACG meeting in San Diego
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ACG: American College of Gastroenterology Poster - Acute Gastric Dilation
- 1. • NPO and nasogastric decompression. • Refeeding syndrome after the initiation of TPN. • EGD showed a large dilated stomach, and no obvious obstruction to the level of jejunum. Biopsies showed severe erosive gastritis. • MR enterography after 3 days of nasogastric decompression showed resolution of his gastric dilation and no evidence of small bowel obstruction. Acute gastric dilation in a severely malnourished patient with UC" Edwin K. McDonald1, Garth R. Swanson1, Sohrab Mobarhan1" 1. Gastroenterology, Rush University, Chicago, IL, United States. "RUSH Intro:" Acute gastric dilation is a rare condition. Gastric perforation, shock, and death are possible complications. Here we discuss a case in a patient with UC and severe malnutrition. HPI:" A 63 year-old male with a history of ulcerative colitis requiring colectomy with end ileostomy, J-pouch formation, and subsequent ileostomy take down that was complicated by chronic diarrhea and weight loss presented with 2 days of nausea, vomiting, and abdominal pain. A CT AP in the ED showed a severely dilated stomach. Exam/Labs:" BMI was 18.3. Afebrile Exam: Profound abdominal distension and cachexia. Labs: WBC 11.86, creatinine 1.6, CRP <5. Fig 1. Abdominal CT demonstrating a severely dilated stomach measuring 33.1x12.8 x 11.3 cm extending to the level of the pelvis. Imaging:" Fig 2. Upper GI series several months prior demonstrated a normal stomach. Hospital Course:" Discussion: " Acute gastric dilatation is a rare and poorly understood condition. Complications including gastric perforation have been attributed to elevated intra-gastric pressure. There is a well documented association with anorexia/bulimia nervosa. Our case of acute gastric dilation in a malnourished patient with ulcerative colitis suggests that co-existing malnutrition may contribute to the pathogenesis of this entity. References:" "Steen et al. Acute gastric dilation and ischemia secondary to small bowel obstruction. Proc (Bayl Univ Med Cent) (2008) vol. 21 (1) pp. 15-7 Powell et al. Gastric necrosis associated with acute gastric dilatation and small bowel obstruction. Gynecol Oncol (2003) vol. 90 (1) pp. 200-3 Fig 3. EGD showed a large dilated stomach, and no obvious obstruction to the level of jejunum.