1246

Abstract

History: An obese 15 y/o male presented to our facility following a pedestrian vs. car accident. His injuries included: pelvic fracture, pneumothorax, lung contusions, clavicle fracture, and 11% BSA burns. He also had rhabdomyolysis, which resolved. He did not require mechanical ventilation. On postinjury day #4, he underwent repair of the pelvis. On postinjury day #5, he underwent burn wound excision and skin grafting. That evening, we were called because he had a fever and new-onset ST segment elevations on telemetry leads. The patient denied chest pain, shortness of breath, or abdominal pain. On exam: T 38.7, p117, r 16, bp 137/66, SpO2 100% on one liter nasal cannula oxygen. General: no distress. Heart: tachycardia. Lungs: clear. Abdomen: soft, not tender, not distended. Legs: no edema. A 12 lead EKG demonstrated sinus tachycardia and new ST segment elevations in inferolateral leads. Labs: potassium 4.3 mmol/L, magnesium 1.8 mg/dL, and calcium 7.5 mg/dL. Hemoglobin was 9.8 g/dL. Troponins x3 were negative. Chest x-ray indicated gastric distention. Abdominal x-ray demonstrated marked stomach distention with gas. A nasogastric tube was placed, with evacuation of a few hundred mL of fluid. Follow-up imaging demonstrated substantially reduced stomach distention. After gastric decompression, the ST segment changes resolved on telemetry. Repeat EKG demonstrated complete resolution of the inferolateral ST segment elevations, no q waves, and persistent sinus tachycardia. The QRS axis remained within normal limits. The patient was asymptomatic. Discussion: While changes in the QRS axis with stomach distention have been described, to our knowledge, there are no English-language case reports with ST segment elevation secondary to gastric distention in pediatric trauma patients. We could only locate an English-language case report of a middle aged female with chest pain who had primarily T wave inversion and slight ST elevation secondary to gastric distention; cardiac work-up was negative. Conclusion: This case illustrates the need to consider acute gastric distention in the differential of acute ST segment elevation/myocardial infarction.