Past surgical history was notable for a right foot debridement for osteomyelitis. His comorbidities included diabetes mellitus and chronic hepatitis C. Cardiopulmonary exam was within normal limits. On examination, his abdomen was distended with decreased bowel sounds and he was noted to have a left lower extremity infected diabetic foot ulcer. On presentation, he was hypothermic (94.5☏) but otherwise hemodynamically stable. The patient was unable to provide a history, however, accompanying family members reported periods of confusion and falls for the past 1 day. He was monitored in the intensive care unit, and over the next few days his DKA resolved, he was extubated and eventually discharged home.Ī 59-year-old male was brought to our institute by emergency services for altered mental status and a “very high” blood sugar reading. Upper endoscopy was contemplated but deferred due to the resolution of dilatation. A repeat AXR 4 hours later revealed resolution of gastric dilatation, which was confirmed by a CT scan of the abdomen.

An NGT was passed which drained over 500 mL of gastric content. An AXR revealed acute gaseous distention of the stomach (Fig. He was started on intravenous (IV) insulin for the treatment of DKA and IV epinephrine for hemodynamic shock. Initial lab data revealed a blood glucose of 1,155 mg/dL and a pH of 6.97 with an elevated anion gap. On examination, his abdomen was notably distended and bowel sounds were sluggish.

He denied the use of tobacco, alcohol, or illicit drugs and had no known drug allergies. His surgical history was significant for a right foot trans-metatarsal amputation. He denied any prior symptoms of delayed gastric emptying, such as nausea, postprandial fullness, or early satiety. His comorbidities included type 1 diabetes and end-stage renal disease. He was noted to be lethargic, hypotensive (76/49 mm Hg), and hypoxic (SaO 2 88%) on presentation and was emergently intubated for airway protection. Due to a lack of awareness, only one of the patients was treated promptly with a nasogastric tube (NGT) placement for decompression.Ī 30-year-old male presented to our institute with complaints of nausea, vomiting, decreased oral intake, and diffuse abdominal pain for the past 3 days. We present our experience of 2 such patients, who presented with severe hyperglycemia and were found to have AGD on imaging. This is particularly seen in patients presenting with diabetic ketoacidosis (DKA) or in a hyperosmolar hyperglycemic state, with marked elevations in blood sugar levels. The focus of treatment is on techniques to decompress the stomach.Īlthough gastroparesis is known to cause AGD, rarely acute hyperglycemia by itself may also predispose to it. However, with AGD, the stomach's vascular supply may become compromised, and this can prove fatal if sequelae, such as gastric emphysema, ischemia, and perforation, occur. The stomach is considered a thick-walled organ, relative to the rest of the gastrointestinal tract, boasting a rich vascular supply. Nonmechanical etiologies include eating disorders (anorexia/bulimia nervosa, psychogenic polyphagia), Prader-Willi syndrome, medications, electrolyte abnormalities, resuscitation, and gastroparesis. Causes of mechanical obstruction include postsurgical strictures/adhesions, pyloric stenosis, gastric volvulus, and superior mesenteric artery syndrome. It is a rare condition and is often overlooked by physicians due to a lack of awareness.ĪGD can result from either mechanical obstruction or nonmechanical distention of the stomach. It is generally described as the radiological finding of a massively enlarged stomach, with gas or fluid, as seen on plain film abdominal X-ray (AXR) or computerized tomography (CT) scan of the abdomen. Duplay in 1833, and although a handful of reports have followed since, no precise definition of this entity is available in the literature. Acute gastric dilatation (AGD) was first reported by S.E.

Gastric bubble in diabetic coma x ray