Gastric rapture 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 diagnosising GRAGD and stabilizing her shock with mas sive 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 diagnosising gastric diste ntion 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 h ad no chance for surgery. Case 3: The patient had sudden abdominal pain, di stention and vomitting with severe shock for 4 days. Emergency surgery foun d gastric rupture and the method was the same as Case 1. The patient surviv ed but has brain impairment. Case 1 and 3 showed multifocal transmural necr osis. Conclusions Symptoms like overeating, bulimia, changes in kind of food, X-r ay showing large distended stomach and massive pneumoperitoneum were seen a fter gastric rupture and can help to diagnose this condition. Clinical cour se of gastric distention with toxic shock progresses rapidly, however subse quent gastric rupture exacerbates the shock and snakes the treatment diffic ult 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 ver y important that when gastric distention disappears after conservative ther apy, the doctor should assess carefully whether the gastric wall recovery i s under way by using effective methods of examination.