Original article | Volume 33, Article 8, 07 May 2019 | 10.11604/pamj.2019.33.8.18769

Acute massive gastric distension in acute pancreatitis

Susanta Meher, Nishant Debta

Corresponding author: Susanta Meher, Department of Surgery, Vikash Multispeciality Hospital, Bargarh, Odisha, India

Received: 06 Apr 2019 - Accepted: 26 Apr 2019 - Published: 07 May 2019

Domain: General surgery

Keywords: Acute pancreatitis, massive gastric distension, perforation peritonitis

©Susanta Meher et al. Pan African Medical Journal (ISSN: 1937-8688). This is an Open Access article distributed under the terms of the Creative Commons Attribution International 4.0 License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Cite this article: Susanta Meher et al. Acute massive gastric distension in acute pancreatitis. Pan African Medical Journal. 2019;33:8. [doi: 10.11604/pamj.2019.33.8.18769]

Available online at: https://www.panafrican-med-journal.com/content/article/33/8/full

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Original article

Acute massive gastric distension in acute pancreatitis

Acute massive gastric distension in acute pancreatitis

Susanta Meher1,&, Nishant Debta2

 

1Department of Surgery, Vikash Multispeciality Hospital, Bargarh, Odisha, India, 2Department of Medicine, Vikash Multispeciality Hospital, Bargarh, Odisha, India

 

 

&Corresponding author
Susanta Meher, Department of Surgery, Vikash Multispeciality Hospital, Bargarh, Odisha, India

 

 

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A 43 year old male patient presented to our emergency department with complain of severe abdominal pain for five days associated with fever, vomiting and non-passage of flatus and stool. The pain started in the epigastric region which became diffused in the subsequent days. Last two days patient had history of breathlessness and decreased urination. On examination patient was looking toxic with tachycardia (124/min) and tachypnea (26/min) with rapid and shallow breathing. Abdominal examination revealed a rigid abdomen with tympanic notes with absent bowel sound. Laboratory investigations showed leukocytosis (15,000/cmm) with raised serum urea (235mg/dl) and creatinine (5.3mg/dl). There was no gas under diaphragm on abdominal X-Ray (A). With high degree of suspicion of perforation peritonitis, a diagnostic peritoneal tapping was done from right lower abdomen and altered colored bilious fluid was aspirated. Patient was resuscitated and planned for emergency laparotomy, which revealed a massively distended stomach covering almost whole of the abdomen (B, C). Duodenum and proximal part of jejunum was also dilated without any mechanical obstruction. Pancreas appeared edematous and bulky with saponification near the root of mesentery. Post-operative serum amylase (494u/l) and lipase (211u/l) as well as peritoneal fluid amylase (826u/l) levels were high, suggestive of acute edematous pancreatitis. Peritoneal tapping is sometime used to detect sealed perforation in cases with signs of peritonitis but without evidence of free gas on radiological investigation. Massive gastric distension in acute pancreatitis is very rare, however peritoneal tapping in such conditions can give a false impression of free fluid (bilious) in the peritoneal cavity.

 

 

Figure 1: (A) X-Ray of the abdomen showing ground glass appearance with a single air-fluid level without any evidence of gas under both domes of diaphragm; (B) massively distended stomach covering almost all the quadrants of the abdomen; (C) massively distended stomach with no evidence of any peritoneal fluid collection

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Original article

Acute massive gastric distension in acute pancreatitis

Original article

Acute massive gastric distension in acute pancreatitis

Original article

Acute massive gastric distension in acute pancreatitis