Gastric Rupture Research Articles

Postmortem gastromalacia

The aim of this case report is to describe the postmortem computed tomography (PMCT) and forensic autopsy investigation findings of a case of antemortem gastric perforation in a dog. A 13-year-old, spayed female, pit bull type dog with a recent history of limping, anorexia, and lethargy, was treated with unknown doses of an unknown corticosteroid, grapiprant (a veterinary nonsteroidal anti-inflammatory drug [NSAID]), and omeprazole, prior to euthanasia. PMCT was subsequently completed, followed by confirmatory forensic autopsy. On PMCT images, a full thickness gastric wall discontinuity with confluent luminal and extraluminal gas (pneumoperitoneum) was identified. In the absence of expected additional sites of postmortem intracavitary gas accumulation (pleural, peri-cardial, and intra-articular) the pneumoperitoneum was attributed primarily to antemortem gastric rupture, which precipitated patient decline and subsequent euthanasia. Forensic autopsy revealed gastric ulceration with perforation. Histological evaluation of the perforation site revealed suppurative inflammation and an early healing response. The combined findings of the PMCT and autopsy were compatible with antemortem gastric perforation attributable to the historical concurrent administration of a NSAID and corticosteroid. Given adequate radiologist knowledge and training, antemortem gastric perforation may be differentiated from postmortem gastromalacia with rupture.

Isolated Double Gastric Perforation in Blunt Abdominal Trauma-a Case Report.

Blunt abdominal trauma mostly results from motor vehicle accidents, recreational accidents, falls or assaults with commonly injured internal organs being the spleen, liver, retroperitoneum, small bowel, kidneys, bladder, colorectal, diaphragm and pancreas. Gastric rupture is quite uncommon. Isolated gastric perforations following blunt trauma to the abdomen are mostly seen in paediatric patients. It is uncommon in adult patients and even rarer is the occurrence of double gastric perforations. We report here with a case of isolated double gastric perforation in a 24-year-old male patient following vehicular accident.

Gastric Rupture after Bag Mask Ventilation: A Review Under a Case Report

Introduction: Bag mask ventilation is considered a safe and effective ventilation method. Despite the high frequency of gastric distension, few cases of gastric rupture are reported in literature. Case report: A 50-year-old female firefighter, ASA 2, was admitted in to the Burn Unit due to 2nd/3rd grade burns (34% of body surface). On the 22nd day after admission, she underwent balneotherapy, under sedation and analgesia and in spontaneous ventilation. During the procedure, desaturation (SpO2 65%) and paradoxical respiratory abdominal movements were noticed. Very high pressures were immediately required for bag-mask ventilation and the bag was difficult to compress. A remarkable increase in abdominal perimeter was evident, leading to the compromise of lower limb circulation. The patient was intubated and a noradrenaline infusion started due to marked hypotension, unresponsive to fluids. Imaging studies revealed a left pulmonary atelectasis and a massive pneumoperitoneum. Emergent exploratory laparotomy demonstrated a gastric laceration in an ischemic mucosa area, which was corrected. The patient was extubated on the first post-operative day, with no further complications. Conclusion: Although bag mask ventilation is a routine practice, it is associated with several complications. Gastric rupture is an extreme rare complication of this technique. The higher incidence of curling ulcers in burned patients may have contributed to gastric rupture and this case stresses the need to consider this potentially lethal complication.

Gastric Rupture-an Uncommon Finding at Autopsy

Gastric rupture, an uncommon finding following blunt abdominal trauma is usually associated with other intra-abdominal injuries. We report such a case of gastric rupture associated with splenic laceration following blunt abdominal trauma. Autopsy revealed an uncommon site of rupture in the posterior wall of the stomach. Possible mechanisms responsible for gastric rupture have been discussed.

Review of gastric rupture in the horse

SummaryGastrointestinal rupture is an important cause and complication of equine colic. The stomach is the most commonly affected segment in the gastrointestinal tract involved in gastrointestinal rupture. Gastric rupture can be primary or secondary; however, unless prodromal clinical signs are identified, localised and corrected, the resulting peritoneal contamination with feed, intestinal secretions and bacteria is invariably fatal. Causes for gastric rupture may be known or idiopathic; however, factors that predispose a horse to gastric rupture are poorly understood. Further research is needed to identify underlying causes and pathophysiology of gastric rupture to prevent it from occurring.

Traumatic double gastric rupture-a rare finding in blunt trauma abdomen

Road traffic accidents are increasingly common, in which blunt trauma abdomen is a common injury with solid organ and hollow viscus injury, but isolated gastric rupture is a rare injury. We report a case of isolated double gastric rupture in blunt trauma abdomen, which is very rare, caused by road traffic accident. Patient managed by immediate laparotomy and double layer closer of both anterior and posterior perforation.

Gastric impaction associated with displacement and volvulus of the large colon in seven mature horses

SummaryGastric impaction associated with large colon volvulus (LCV) was identified in seven horses. Right dorsal displacement of the large colon and suspected nephrosplenic entrapment was identified in 2 of the 7 horses as well as LCV with concurrent gastric impaction. All horses underwent surgery for LCV and none survived. Five horses died or were subjected to euthanasia intraoperatively or in recovery. One horse was subjected to euthanasia post operatively due to persistent gastric reflux, following resolution of the gastric impaction. One horse was subjected to euthanasia post operatively due to a suspected gastric rupture, which was confirmed on post mortem examination. It is hypothesised that a large mass in the cranial abdomen, such as a gastric impaction may disrupt the normal anatomical large colon alignment or may cause colonic motility or microbiota alterations, and thus increase the risk of large colon displacement and volvulus.

Duodenal volvulus as a cause of gastric rupture in a 15‐year‐old Warmblood gelding

SummaryDuodenal volvulus is an unreported cause of colic in the horse. This case report describes a 15‐year‐old Warmblood gelding evaluated for acute abdominal discomfort. Exploratory celiotomy revealed duodenal volvulus and gastric rupture resulting in severe, acute, septic peritonitis. To the authors' knowledge, this is the first report of a volvulus of the equine duodenum.

A Case of Gastric Rupture Resulting from Cardiopulmonary Resuscitation

A Case of Gastric Rupture Resulting from Cardiopulmonary Resuscitation

Trauminio skrandžio plyšimo sepsinių komplikacijų gydymas minimaliai invaziniais metodais: klinikinis atvejis

ĮžangaIzoliuotas trauminis skrandžio plyšimas pasitaiko labai retai. Apie 95 % atvejų diagnozuojami gretutinių organų sužalojimai. Dėl santykinai palankios skrandžio anatomijos, jo mobilumo bei storos sienos skrandžio plyšimai sudaro 0,02–1,7 % visų bukų pilvo sužalojimų. Mūsų tikslas – aprašyti neįprastą trauminį skrandžio plyšimą, gydytą minimaliai invazinės chirurgijosmetodais.Atvejis62 metų vyras skubos tvarka hospitalizuotas į chirurgijos skyrių dėl skausmo epigastriumo srityje ir kraujavimo iš viršutinės virškinimo trakto dalies klinikinių požymių. Ligonis teigė, kad prieš 2 savaites patyrė buką pilvo traumą. Iš anamnezės žinoma apie skrandžio opaligę. Atlikus endoskopinį tyrimą rastas visą mažąją kreivę apimantis skrandžio išopėjimas be aktyvaus kraujavimo požymių. Pilvo organų echoskopijos duomenimis, konstatuota bursa omentalis skysčio sankaupa, priekinės pilvo sienos hematoma ir laisvas skystis pilvo ertmėje (apie 500–700 ml). Įtarta pridengta skrandžio kūno mažosios kreivės perforacija ir hemoperitoneumas. Ligoniui siūlytas skubus operacinis gydymas, bet jis tokio gydymo kategoriškai atsisakė. Konservatyvaus gydymo metu, atsiradus infekcijos požymių, atliktas pilvo organų ultragarsinis ir kompiuterinės tomografijos tyrimai, kuriais nustatyta bursa omentalis skysčio sankaupos ir priekinės pilvo sienos hematomos supūliavimas. Atliktas ultragarsu kontroliuojamas pilvo sienos hematomos dravimas 12 Fr drenu. Endoskopinės procedūros metu per užpakalinę skrandžio sieną drenuotas bursa omentalis pūlinys, į jo ertmę įkišus du 7 Fr drenus. Normalizavosi temperatūra, kraujo tyrimų rodikliai, pacientas pradėjo normaliai valgyti. Geros būklės išrašytas į namus 35 parą nuo hospitalizacijos pradžios. Stebėtas ambulatoriškai. Komplikacijų nekonstatuota. Po 2 mėnesių endoskopiškai pašalinti skrandžio drenai.IšvadaSkrandžio trauminio sužalojimo sepsinės komplikacijos gali būti efektyviai gydomos minimaliai invazinės chirurgijos priemonėmis – perkutaniniu ir endoskopiniu transgastriniu pūlinių drenavimu.

Acute Fetal Asphyxia After Gastric Rupture in a Pregnant Patient With a Gastric Band

We report a 37-year-old primigravida with a gastric band who developed the clinical picture of abdominal pain, vomiting and regurgitation coexistent with a cardiotocogram with severe variable decelerations with absent variability at 33 weeks' gestation. After partial improvement with gastric band enlargement, new aggravation of symptoms and recurrence of a pathological cardiotocogram led to an emergency cesarean section. Intraoperatively, hemoperitoneum from gastric rupture was verified and partial gastrectomy was performed. After bariatric surgery, pregnant women are at increased risk of gastrointestinal complications, which may need prompt and multidisciplinary diagnosis and management in order to avoid maternal-fetal morbidity and mortality.

Histopathological features of cutaneous and gastric habronemiasis in horse.

The aim of study was to describe clinico histopathological manifestations of cutaneous and gastric habronemiasis in horse. The adult worms live on the wall of the stomach and cutaneous of the host without internal migration. A 5year old 700kg warm-blood, cross gelding was referred to the Tehran School of Veterinary Medicine, Veterinary Teaching Hospital. The horse presented skin lesions around. In our survey, several raised granulomatous nodules with a cystic space and parasites within the cysts were observed. Also gastric rupture at greater curvature due to abscess and perforation through the serosa causing diffused peritonitis and subsequent death. Eosinophils and other inflammatory cells were present in large numbers. Furthermore, cutaneous lesions were characterized by single or multiple ulcerated timorous masses with eosinophil epithelioid cell infiltration and scattered necrotic debris. Granulation tissue and neutrophils were observed along the ulcerated area. In this report a case of cutaneous and gastric habronemiasis in a horse in Iran is described with special attention to confirmation of the clinical diagnosis.

English

Introduction: Wilkie's Syndrome (also called SMA Syndrome) is a rare cause of small bowel obstruction, characterized by an extrinsic vascular compression of the third portion of the duodenum between the abdominal aorta and overlying superior mesenteric artery, due to loss of cushion of fat. OBJECTIVES: To aware, diagnose and manage a rare case of Wilkie's Syndrome Methodology: Case suspected clinically, diagnosed by radiological investigations and managed by duodenojejunostomy RESULTS: Clinically, Wilkie's Syndrome presents with postparandial abdominal distension, pain, nausea, vomiting, and weight loss. Fasting, total parenteral nutrition, and gastric decompression constitute usual conservative treatment with a high success rate. Surgery if needed has a low failure rate and consists of creating a gastrojejunostomy or duodenojejunostomy with or without duodenal mobilization (known as the Strong's procedure). CONCLUSION : Wilkie's Syndrome is a rare disorder. Only 500 cases reported worldwide till date. Surgical treatment is the treatment of choice in long standing cases otherwise it may result in fatal complications like advanced malnutrition, electrolyte imbalance, gastric rupture, spontaneous upper GI bleeding or sudden cardiovascular collapse.

G.P.238: Phenotypic spectrum of three patients affected by TRPV4 mutations

Mutations in the TRPV4 (transient receptor potential vanilloid 4) gene, encoding a non-selective cation channel, causes congenital distal spinal muscular atrophy, scapuloperoneal spinal muscular atrophy and inherited motor sensory neuropathy type 2C. Here we report the clinical phenotype of three patients belonging to 2 families that affected member fit with the previously described phenotype in the TRPV4 gene mutations. Patient 1 is the mother of patient 2, current age 44 years old. Symptoms began at 20 years old with difficulties on walking in her heels and developing progressive scapuloperoneal muscle atrophy syndrome and transient dysphonia. Currently she is able to walk independently with bilateral steppage. Marked atrophy of lower legs and scapular musculature sparing forearm and intrinsic hand muscle were observed. Axonal motor neuropathy was confirmed. Genomic studies: heterocygous, c.805C>T mutation in TRPV4 gene. Patient 2: She was born from a normal pregnancy and deliver but with clubfoot and limited knee extension. Severe motor developed was observed being unable to walk or stand up. Deep tendon reflex was abolished and axonal motor neuropathy was confirmed. Because a severe restrictive respiratory and frenic nerve involvement she presented atelectasis, pneumonias and cardio respiratory arrest needing ventilator support and tracheostomies complicated with gastric rupture in one occasion. Genetic studies confirmed the same mutation of her mother. Patient 3: An 18 year old boy had normal motor development. When he was 13 years old he complained loss of strength in upper distal limbs. Present mild weakness of flexor and extensor wrist muscles. Deep tendon reflexes were normal. Axonal motor neuropathy was confirmed. Genetic studies showed a heterocigous mutation, c.1684G>T in TRPV4 gene. TRPV4 gene mutations cause a heterogeneous group of neurodegenerative disorders, characterized by variable penetrance and phenotypic expression for the same mutation.

Gastric perforation after accidental esophageal intubation in a patient with deep neck infection

Deep neck infection with airway obstruction may complicate endotracheal intubation with limited neck motion, pharyngeal swelling, and prominent secretion. Unrecognized esophageal intubation (EI) may unduly overinflate the stomach to inhibit effective ventilation, increase the incidence of hypoxia, and produce a ruptured visceral organ. We report an 81-year-old female patient with deep neck infection and impending respiratory failure who suffered gastric perforation after accidental EI in the intensive care unit. After failed attempts of intubation, EI was recognized rapidly as the culprit, although roughly audible bilateral breathing sounds were present but not gastric bubble sounds. A catastrophic complication of gastric rupture occurred due to ambu-bagging and mechanical ventilation. Surgical intervention was performed immediately. Possible mechanisms are discussed.

A Case of Anorexia Nervosa With Tracheoesophageal Fistula

Patients with anorexia nervosa (AN) may have many complications affecting various organs. Regarding the gastrointestinal tract, acute gastric dilatation and rupture by refeeding or duodenal ileus due to mesenteric artery compression have been reported. Respiratory complications are uncommon in AN. A rare complication is spontaneous pneumomediastinum, and only a few reported cases exist. We report here a case of AN complicated by tracheoesophageal fistula (TEF), which is an abnormal connection between the esophagus and the trachea. To our knowledge, TEF accompanying AN has not been reported in the English literature, although we have reported this condition in Japanese, where we discussed the cause of long-term hospitalization in the light of the limited medical resources for the treatment of physical complications in AN in Japan. Here, we focus our discussion on the pathophysiology, diagnosis, and treatment of TEF in AN. The case we describe should be informative not only for psychiatrists but also surgeons and intensive care specialists who manage the physical complications of AN. Some social and demographic details were altered to anonymize the case.

Fatalities Associated with American Endurance Ride Conference Sanctioned Endurance Rides (2002–2013)

IntroductionFatalities are recognized as a consequence of prolonged endurance exercise but data documenting incidence and causes is limited.MethodsNumbers of horse starts and fatalities were obtained from the American Endurance Ride Conference (AERC) website (www.aerc.org) and further details about fatalities were obtained from horse owners and attending veterinarians. Annual incidence rates were calculated and odds ratios for region and ride length were determined.ResultsFrom 2002–2013 there were 252,738 horse starts in AERC sanctioned rides and 67 fatalities attributable to the demands of endurance exercise were documented. 46/67 horses were eliminated while 21 successfully completed the ride and were deemed fit to continue. Thirteen horses died while euthanasia was performed in the remaining 54 instances, and 51% had necropsy examinations performed. 81% of the fatalities developed acute abdominal pain and necropsy findings included gastric rupture in 12%. Fatalities were also related to financial constraints as 28% of riders declined fluid therapy, referral to surgical facilities, and/or surgery when recommended. Horses competing in the Central and Midwest regions appeared at lesser risk, while those in the Southwest and Northeast regions appeared at greater risk, but low numbers of fatalities precluded reaching statistical significance. In contrast, the risk of fatality was 2 (1 fatality per 3,711 starts) and 12 (1 fatality per 648 starts) times more likely for participation in 80 and 160 km rides, as compared to competition in Limited Distance (40 to 56 km) rides (1 fatality per 8,057 starts).ConclusionsOverall fatality rates were low; however, risk increased with ride distance. Acute abdominal pain was the most common clinical presentation.Ethical Animal ResearchThis retrospective study used data available on the American Endurance Ride Conference (AERC) website and additional documents provided by the AERC. Sources of funding: none. Competing interests: Dr. Balch is a member of AERC Veterinary Committee, Research Committee, and Board of Directors and Dr. Schott is a member of the AERC Research Committee.

Recurrent Gastric Dilatation and Intestinal Dysmotility Possibly Resulting from Autonomic Neuropathy in a Great Dane

A 5 yr old female spayed Great Dane was presented for recurrent episodes of gastric dilatation, intestinal dysmotility, and one episode of gastric rupture. Numerous hematologic, radiographic, and endocrine diagnostic tests were performed with no identifiable underlying cause. Many risk factors have been identified for gastric dilatation and most were present in this Great Dane. A number of symptomatic treatments, aimed primarily at altering the gastrointestinal tract flora and motility were tried, but failed to influence the clinical course of the disease. The dog continued to worsen, experienced more frequent episodes of gastric dilatation, and developed generalized muscle atrophy. Biopsies were collected from the biceps femoris and triceps brachii muscles. A pattern of denervation atrophy was evident in both muscles, consistent with polyneuropathy. The owners elected humane euthanasia and a necropsy was performed. A striking finding at necropsy was severe loss of myelinated fibers with extensive endoneurial fibrosis in the vagus nerve, consistent with an autonomic neuropathy. Autonomic neuropathy is a previously unexplored cause of gastric dilatation and intestinal dysmotility in dogs. These findings should open new directions for exploring pathogenic mechanisms for gastric dilatation in this species.

Fetal stomach paracentesis in combined duodenal and esophageal atresia

Fetuses with concomitant duodenal atresia (DA) and esophageal atresia (EA) might develop in utero gastric rupture as well as neonatal respiratory complication due to dilated stomach and duodenum. Our patient with the typical "double bubble" appearance was highly suspected to have DA in the second trimester. Follow-up examinations revealed a massively dilated stomach and duodenum with a dilated distal esophagus, indicating concomitant DA and EA. With advancing pregnancy, the fetal abdomen progressively increased in size by retention of fluid in the closed loop of DA and EA. To avoid gastric perforation, prenatal stomach paracentesis using an ultrasound-guided needle was performed three times until delivery. A male neonate born at 37weeks gestation showed no respiratory complication. Perinatal clinical features and operative findings revealed combined DA and EA (gross type A). He was successfully managed with duodenoduodenostomy, followed by esophago-esophagostomy. On fetal sonography, the marked "double bubble" appearance and the cystic structure presenting peristalsis-like movement above the diaphragm were indicative of concomitant DA and EA. Fetal stomach paracentesis could contribute to the improvement of perinatal outcomes in fetuses with this pathological condition.

Risk Factors for Rebleeding and Prognostic Factors for Postoperative Survival in Patients with Balloon-Occluded Retrograde Transvenous Obliteration of Acute Gastric Variceal Rupture

Balloon-occluded retrograde transvenous obliteration (B-RTO) has shown great potential in controlling acute gastric variceal hemorrhage, although rebleeding related to the procedure may occur in a small percentage of patients. The purpose of this study was to identify risk factors of perioperative rebleeding and prognostic factors of postoperative survival in B-RTO performed for acute episodes of gastric variceal hemorrhage. We retrospectively analyzed 39 consecutive patients who underwent B-RTO for gastric variceal rupture at our hospital between June 2003 and May 2011. Uni- and multi-variate analyses were performed to assess risk factors for perioperative rebleeding and prognostic factors for postoperative survival. Surgical success and complete eradication of varices were achieved in 36 cases (92.3 %) and 35 cases (89.7 %), respectively. Six patients experienced rebleeding either intraoperatively (n = 3) or within 1 h after B-RTO (n = 3). Child-Pugh class C was identified as a risk factor for rebleeding on univariate (P = 0.018) and multivariate analyses (odds ratio, 6.003; P = 0.014). With a median follow-up of 23 months (range 0-106.6 months), overall survival rates at 1, 3, and 5 years were 91.7, 74.7, and 67.2 %, respectively. Multivariate analyses revealed Child-Pugh class C as a prognostic factor for survival (relative risk, 4.014; P = 0.023). Although B-RTO is generally effective in the treatment of acute gastric variceal rupture, patients classified as Child-Pugh class C have a higher risk of perioperative rebleeding and shorter survival.