•  NPO and nasogastric decompression. •  Refeeding syndrome after the initiation of TPN. •  EGD showed a large dilated stomach, and no obvious

obstruction to the level of jejunum. Biopsies showed severe erosive gastritis.

•  MR enterography after 3 days of nasogastric decompression showed resolution of his gastric dilation and no evidence of small bowel obstruction.

Acute gastric dilation in a severely malnourished patient with UC"

Edwin K. McDonald1, Garth R. Swanson1, Sohrab Mobarhan1"

1. Gastroenterology, Rush University, Chicago, IL, United States. "RUSH Intro:"

Acute gastric dilation is a rare condition. Gastric perforation, shock, and death are possible complications. Here we discuss a case in a patient with UC and severe malnutrition.

HPI:"A 63 year-old male with a history of ulcerative colitis requiring colectomy with end ileostomy, J-pouch formation, and subsequent ileostomy take down that was complicated by chronic diarrhea and weight loss presented with 2 days of nausea, vomiting, and abdominal pain. A CT AP in the ED showed a severely dilated stomach.

Exam/Labs:"BMI was 18.3. Afebrile Exam: Profound abdominal distension and cachexia. Labs: WBC 11.86, creatinine 1.6, CRP <5.

Fig 1. Abdominal CT demonstrating a severely dilated stomach measuring 33.1x12.8 x 11.3 cm extending to the level of the pelvis.

Imaging:"

Fig 2. Upper GI series several months prior demonstrated a normal stomach.  

Hospital Course:"

Discussion: "Acute gastric dilatation is a rare and poorly understood condition. Complications including gastric perforation have been attributed to elevated intra-gastric pressure. There is a well documented association with anorexia/bulimia nervosa. Our case of acute gastric dilation in a malnourished patient with ulcerative colitis suggests that co-existing malnutrition may contribute to the pathogenesis of this entity.

References:""Steen et al. Acute gastric dilation and ischemia secondary to small bowel

obstruction. Proc (Bayl Univ Med Cent) (2008) vol. 21 (1) pp. 15-7 Powell et al. Gastric necrosis associated with acute gastric dilatation and small bowel obstruction. Gynecol Oncol (2003) vol. 90 (1) pp. 200-3

Fig 3. EGD showed a large dilated stomach, and no obvious obstruction to the level of jejunum.