3244 Acute Massive Gastric Distention in an Adult Patient With Cerebral Palsy

Abstract

INTRODUCTION: Cerebral Palsy (CP) is a motor impairment secondary to neurological abnormalities in the central and peripheral nervous systems. CP can affect the functioning of the gastrointestinal system. Common complications include dysphagia, constipation, regurgitation, vomiting and gastroesophageal reflux. Severe gastric distension is a very rare complication of CP with a high mortality risk. We present a case of severe gastric distension in a patient with CP. CASE DESCRIPTION/METHODS: A non-verbal 39-year-old man with history of CP, spastic quadriplegia, deep vein thrombosis, and obstipation status post colectomy and subtotal ileostomy presented with a 2-day history of poor oral intake, abdominal distention, and decreased ileostomy output. Patient had a similar presentation one-month prior. Vitals were within normal. Physical exam showed abdominal distension, abdominal tenderness, absent bowel sounds and tympany to percussion. Labs were normal except for hemoglobin of 8.3 g/dL, blood urea nitrogen of 42 mg/dL and a creatinine of 1.65 mg/dL. Computerized tomography showed markedly dilated stomach with air-fluid levels. Patient was placed on nothing by mouth. A nasogastric tube was placed to suction. An endoscopy was done that was negative for gastric outlet obstruction (GOO). Xrays showed resolution of the gastric distension. Patient tolerated liquids and then solids. He began to have stool output from the ileostomy and was discharged. DISCUSSION: Gastric distension in patients with CP is not fully understood. Gastric emptying and motility of the foregut are regulated by the vagus nerve. Predisposing factors include autonomic neuropathy, neuromuscular incoordination, air swallowing and malposition of the stomach. Death may be due to respiratory compromise by lung compression from a dilated stomach, or rupture of the stomach. Gastric distension can be seen in patients with GOO or diabetes mellitus with gastroparesis. Another cause is severe kyphoscoliosis of the vertebral columns causing malpositioning and posterior displacement resulting in mechanical obstruction preventing spontaneous decompression. In cases of recurrent or severe gastric distension, worsening of symptoms, or non-resolving distension after supportive management a venting gastrostomy may be needed. Severe gastric dilatation, with or without rupture, should be considered a potential cause of unexpected death in individuals with severe mental and physical disabilities.