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Acute gastric dilatation causing respiratory distress.

Cox A, Marks DJ - JRSM Short Rep (2011)

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Barnet General Hospital , London , UK.

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Emergency management of two cases of acute gastric dilatation are discussed, causing respiratory compromise and requiring active decompression with nasogastric tube... An ECG confirmed sinus rhythm without ischaemic changes... On respiratory examination there were globally reduced breath sounds consistent with hypoventilation... A 72-year-old man with type 2 diabetes mellitus and severe Parkinson's disease was referred to the acute medical on-call team with a 4-day history of nausea and vomiting, and mild abdominal discomfort... Examination revealed profound bradykinesia, tachypnoea with a respiratory rate of 22/min, a pulse rate of 95 bpm, but normotension at 115/85 mmHg and oxygen saturation of 97% on air... Acute gastric dilatation is a rare cause of acute dyspnoea and respiratory compromise, which may as in our cases require emergency decompression... It constitutes a surgical emergency, as delayed treatment can result in gastric necrosis, perforation, abdominal compartment syndrome and severe sepsis... The causes are varied, but either cause physical obstruction or profound dysmotility (Box 1), and often multiple factors act in synchrony in individual patients... As in case 1, active aspiration may be required as drainage will not always be achieved spontaneously... Should attempts at inserting a nasogastric tube be unsuccessful, placement under direct endoscopic or fluoroscopic guidance may be required... If these too are unsuccessful, or there is suspicion of a perforation or abdominal compartment syndrome, emergency laparotomy should be organized... We present two cases of acute gastric dilatation causing respiratory compromise, presenting to both the surgical and medical on-call teams... Both required emergency active decompression with nasogastric tubing.

No MeSH data available.


AP erect chest plain radiograph of case 2 showing severely decreased lung fields, especially of the left hemi-diaphragm and the superior half of the enlarged gastric shadow seen in the abdominal radiograph of the same patient
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SHORTS-11-017F2: AP erect chest plain radiograph of case 2 showing severely decreased lung fields, especially of the left hemi-diaphragm and the superior half of the enlarged gastric shadow seen in the abdominal radiograph of the same patient

Mentions: A 72-year-old man with type 2 diabetes mellitus and severe Parkinson's disease was referred to the acute medical on-call team with a 4-day history of nausea and vomiting, and mild abdominal discomfort. Examination revealed profound bradykinesia, tachypnoea with a respiratory rate of 22/min, a pulse rate of 95 bpm, but normotension at 115/85 mmHg and oxygen saturation of 97% on air. An electrocardiogram demonstrated sinus rhythm without ischaemia. There was reduced chest expansion bilaterally with quiet breath sounds; the abdomen was swollen and tense, tympanic, but relatively painless. No succussion splash was elicited. A plain abdominal film revealed a grossly enlarged gastric shadow (Figure 1). CXR revealed under-inflated lung fields with no pneumoperitoneum (Figure 2). Blood showed elevated white cell count of 27.2 × 109/L and C-reactive protein of 369 mg/L, and acute renal failure with a urea of 23.7 mmol/L and creatinine of 270 µmol/L.


Acute gastric dilatation causing respiratory distress.

Cox A, Marks DJ - JRSM Short Rep (2011)

AP erect chest plain radiograph of case 2 showing severely decreased lung fields, especially of the left hemi-diaphragm and the superior half of the enlarged gastric shadow seen in the abdominal radiograph of the same patient
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3105458&req=5

SHORTS-11-017F2: AP erect chest plain radiograph of case 2 showing severely decreased lung fields, especially of the left hemi-diaphragm and the superior half of the enlarged gastric shadow seen in the abdominal radiograph of the same patient
Mentions: A 72-year-old man with type 2 diabetes mellitus and severe Parkinson's disease was referred to the acute medical on-call team with a 4-day history of nausea and vomiting, and mild abdominal discomfort. Examination revealed profound bradykinesia, tachypnoea with a respiratory rate of 22/min, a pulse rate of 95 bpm, but normotension at 115/85 mmHg and oxygen saturation of 97% on air. An electrocardiogram demonstrated sinus rhythm without ischaemia. There was reduced chest expansion bilaterally with quiet breath sounds; the abdomen was swollen and tense, tympanic, but relatively painless. No succussion splash was elicited. A plain abdominal film revealed a grossly enlarged gastric shadow (Figure 1). CXR revealed under-inflated lung fields with no pneumoperitoneum (Figure 2). Blood showed elevated white cell count of 27.2 × 109/L and C-reactive protein of 369 mg/L, and acute renal failure with a urea of 23.7 mmol/L and creatinine of 270 µmol/L.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Barnet General Hospital , London , UK.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Emergency management of two cases of acute gastric dilatation are discussed, causing respiratory compromise and requiring active decompression with nasogastric tube... An ECG confirmed sinus rhythm without ischaemic changes... On respiratory examination there were globally reduced breath sounds consistent with hypoventilation... A 72-year-old man with type 2 diabetes mellitus and severe Parkinson's disease was referred to the acute medical on-call team with a 4-day history of nausea and vomiting, and mild abdominal discomfort... Examination revealed profound bradykinesia, tachypnoea with a respiratory rate of 22/min, a pulse rate of 95 bpm, but normotension at 115/85 mmHg and oxygen saturation of 97% on air... Acute gastric dilatation is a rare cause of acute dyspnoea and respiratory compromise, which may as in our cases require emergency decompression... It constitutes a surgical emergency, as delayed treatment can result in gastric necrosis, perforation, abdominal compartment syndrome and severe sepsis... The causes are varied, but either cause physical obstruction or profound dysmotility (Box 1), and often multiple factors act in synchrony in individual patients... As in case 1, active aspiration may be required as drainage will not always be achieved spontaneously... Should attempts at inserting a nasogastric tube be unsuccessful, placement under direct endoscopic or fluoroscopic guidance may be required... If these too are unsuccessful, or there is suspicion of a perforation or abdominal compartment syndrome, emergency laparotomy should be organized... We present two cases of acute gastric dilatation causing respiratory compromise, presenting to both the surgical and medical on-call teams... Both required emergency active decompression with nasogastric tubing.

No MeSH data available.