Acute massive gastric dilatation Romanian Journal of Gastroenterology September 2005 Vol.14 No.3, 279-283 Address for correspondence: Sorinel Luncã Clinica de Urgenþe Chirurgicale Spitalul Clinic de Urgenþe Str. General Berthelot no.2 Iaºi, Romania E-Mail: slunca@hotmail.com Acute Massive Gastric Dilatation: Severe Ischemia and Gastric Necrosis without Perforation Sorinel Luncã 1 , Andrew Rikkers 2 , Alexandru Stãnescu 2 1) Emergency Surgical Clinic, University of Medicine and Pharmacy “Gr. T. Popa” Iaºi., Romania. 2) IRCAD/EITS, University of Medicine “Louis Pasteur” Strasbourg, France Abstract Acute massive gastric dilatation is a rare event and though it can occur in a multitude of medical conditions, its pathogenesis is still debated. It leads almost invariably to gastric necrosis with or without perforation which calls for emergency surgical treatment. We present the case of a 22 year-old male patient of normal weight with acute massive gastric dilatation due to a binge eating episode leading to gastric parietal ischemia with mucosal necrosis. Abdominal computed tomography established the diagnosis of acute massive gastric dilatation. After partial decompression of the stomach, the patient emptied his stomach by vomiting. Eight hours after gastric decompression, an upper endoscopy was performed showing ischemia with areas of necrotic gastric mucosa in the fundus and along the greater curvature. Despite presence of ischemia and gastric necrosis, conservative treatment was successful. Psychiatric assessment revealed a borderline mentally retarded young man, but no current diagnosis of a typical eating disorder. Physicians should be aware that binge eating habits may cause acute massive gastric dilatation in patients of normal weight who are not diagnosed as having a typical eating disorder. Prompt diagnosis of acute gastric dilatation and decompression of the stomach even when gastric ischemia and mucosal necrosis is present, may avoid unnecessary laparotomy. Key words Acute massive gastric dilatation - gastric ischemia - eating habits - partial decompression - conservative treat- ment Rezumat Dilataþia acutã gastricã masivã reprezintã un eveniment rar, întâlnit totuºi în numeroase afecþiuni, ºi a cãrui patogenezã este încã discutatã. Dilataþia acutã gastricã masivã conduce aproape invariabil la necrozã gastricã cu sau fãrã perforaþie, ceea ce necesitã tratament chirurgical de urgenþã. Prezentãm cazul unui pacient de 22 de ani de sex masculin, cu greutate normalã, cu dilataþie acutã gastricã masivã survenitã dupã un acces bulimic ºi care a dezvoltat o ische- mie a peretelui gastric cu necrozã a mucoasei. Diagnosticul de dilataþie acutã masivã a fost stabilit prin examen computer tomografic. Dupã decomprimarea parþialã a stomacului, pacientul evacueazã complet stomacul prin efort de vãrsãturã. Dupã 8 ore, examenul endoscopic a relevat prezen- þa de arii necrotice extinse la nivelul fundusului ºi marii curburi gastrice. Tratamentul conservator a avut succes, deºi au fost prezente fenomene ischemice severe parietale gastrice. Evaluarea psihiatricã a stabilit profilul unui pacient la limita retardului mental, necunoscut ca având tulburãri ale obiceiurilor alimentare. Medicul trebuie sã fie conºtient cã un episod de bulimie poate conduce la dilataþie acutã gastricã masivã chiar la pacienþi cu greutate normalã ºi care nu sunt cunoscuþi cu tulburãri de alimentaþie. Un diagnostic prompt ºi decompresiunea stomacului pot conduce la evitarea unei laparotomii inutile, chiar în prezenþa ischemiei parietale ºi necrozei mucoase. Introduction The incidence of acute gastric dilatation (AGD) is quite rare compared with other gastric pathologies, with relatively few references in the literature, most of them as case reports. AGD is encountered most often as a postoperative complication in abdominal surgery and in a multitude of disorders, such as anorexia and bulimia nervosa, psycho- genic polyphagia, trauma, diabetes mellitus etc. (1-5). The pathogenesis of AGD is still unclear, with different theories