Fatal Outcome in a Patient with Acute Dilatation of Stomach without Perforation – A Case Report

Abstract

Aims: Acute gastric dilatation (AGD) is the radiological finding of a massively enlarged stomach as seen on a plain film x-ray or CT scan of the abdomen. Due to a lack of physician awareness, it may go undiagnosed and has a high mortality if not treated promptly. Multiple aetiologies exist in this condition which can lead to ischemic necrosis and perforation of the stomach. We report its presentation in a patient of schizophrenia on anti-psychotic and anti-muscarinic agents, to share our challenges in diagnosing and treating this condition. Presentation of Case: A 41-year-old patient presented with acute pain abdomen and distension. The patient was hemodynamically unstable. Blood analysis showed leucocytosis and raised CRP whereas serum amylase was normal. Straight X-ray abdomen showed gaseous dilatation of stomach. Patient did not improve on conservative management. Exploratory laparotomy revealed a hugely dilated stomach. Gastric decompression with anterior gastrostomy with gastropexy was performed. Patient was kept in intubated state in the post operative period in ICU and was maintained on antibiotics and inotropes. Although recovering initially, he succumbed on post operative day 3, due to multi organ dysfunction syndrome. Discussion: AGD is an emergency requiring immediate intervention. Early detection by clinical examination and imaging followed by surgical intervention is the key for managing AGD. Conclusion: Our case report demonstrates the importance of clinical identification of AGD and subsequent diagnosis and management. A patient with acute onset abdominal distention should be urgently investigated by proper imaging modalities. Recognition and diagnosis of this condition is required for appropriate patient management. In addition, our case report adds to the complication of antipsychotic and antimuscarinic agents resulting in this condition.