Gastric rupture caused by acute gastric distention in non-neonatal children: clinical analysis of 3 cases.
OBJECTIVE
To study gastric rupture, a progressive, rapid and high mortality condition, caused by acute gastric distention (GRAGD) and its appropriate diagnosis and treatment.


METHODS
The etiology, pathology, clinical manifestations and experiences in 3 children with GRAGD were reviewed.


RESULTS
Case 1: After diagnosing GRAGD and stabilizing her shock with massive fluid replacement, gastrostomy was performed. Her postoperative course was uneventful because of fasting, suction, fluid infusion, correction of acidosis and supporting nutrition. Case 2: After diagnosing gastric distention which subsided with conservative therapy for 9 days, she suddenly had gastric rupture when she had not eaten for 6 days. She died of shock and had no chance for surgery. Case 3: The patient had sudden abdominal pain, distention and vomiting with severe shock for 4 days. Emergency surgery found gastric rupture and the method was the same as Case 1. The patient survived but has brain impairment. Case 1 and 3 showed multifocal transmural necrosis.


CONCLUSIONS
Symptoms like overeating, bulimia, changes in kind of food, X-ray showing large distended stomach and massive pneumoperitoneum were seen after gastric rupture and can help to diagnose this condition. Clinical course of gastric distention with toxic shock progresses rapidly, however subsequent gastric rupture exacerbates the shock and makes the treatment difficult treatment. It is extremely important that a laparotomy be performed at once after stabilizing shock with massive fluid replacement. Postoperative nutritional support and fluid replacement will increase survival. It is very important that when gastric distention disappears after conservative therapy, the doctor should assess carefully whether the gastric wall recovery is under way by using effective methods of examination.
Qin
H
H
Department of Surgery, Beijing Children's Hospital, Beijing 100045, China.
Yao
H
H
Zhang
J
J
D015746:Abdominal Pain / Q000209:etiology; D002648:Child; D002675:Child, Preschool; D017809:Fatal Outcome; D005260:Female; D013271:Gastric Dilatation / Q000150:complications*; D006801:Humans; D007223:Infant; D013275:Stomach Rupture / Q000209:etiology / Q000601:surgery*; D014839:Vomiting / Q000209:etiology