2771 Acute Gastric Dilatation: A Cause for Concern

Abstract

INTRODUCTION: Gastroparesis in diabetics can be worsened by hyperglycemia. Acute elevations in blood glucose suppress the frequency and contraction amplitude of antral pressure waves while stimulating phasic pyloric pressure waves, which can result in Acute Gastric Dilatation (AGD). Though an unusual occurrence, it requires a high degree of suspicion to avoid its rare but life-threatening complications. We present our experience of two patients with AGD. CASE DESCRIPTION/METHODS: Case 1: A 30-year-old male presented to the ER with nausea, vomiting and abdominal pain. His comorbidities included type 1 diabetes and end-stage renal disease. On examination, his abdomen was notably distended and bowel sounds were sluggish. No guarding or rigidity was appreciated. He was hypotensive (76/49 mmHg) and hypoxic. Lab values were significant for blood glucose of 1155 mg/dL and a pH of 6.97. He was emergently intubated and started on IV insulin and Epinephrine. An abdominal plain film x-ray showed acute gaseous distention of the stomach. An NG tube was passed which drained 500cc of brownish gastric content. A repeat x-ray 4 hrs later revealed resolution of gastric dilatation which was confirmed by CT-abdomen. Patient's abdominal symptoms improved thereafter and he made a full recovery in time. Case 2: 59-year-old male was brought to the ER with an altered mental status. As per EMS, he had “very high” blood sugar levels. His comorbidities included diabetes mellitus and chronic hepatitis C. His abdomen was distended with decreased bowels sounds. His vital signs were stable. Lab values were significant for hyperglycemia (649 mg/dL), and a blood pH of 7.29. He underwent an abdominal x-ray which showed marked distention of the stomach. A follow-up CT abdomen confirmed the finding, with no mechanical cause of obstruction identified. He was started on IV Insulin, IV antibiotics and was planned for endoscopic workup, however, his conditioned rapidly deteriorated and he required pressors with mechanical ventilation. The patient eventually suffered a cardiac arrest and was unable to be revived. DISCUSSION: AGD presents with nausea, vomiting, succussion splash, and abdominal distension. Acute hyperglycemia in uncontrolled diabetics is the precipitating factor. If intragastric pressures exceed 20 cmH20 (lower limit of gastric venous pressure), it can cause mucosal ischemia and necrosis. This may be followed by perforation, which has a high mortality rate. Emergency decompression with NG tube seems to be the treatment of choice.