Massive gastric dilation complicating diabetic gastroparesis

Area of Science:

• Gastroenterology
• Abdominal Surgery
• Medical Imaging

Background:

• A middle-aged male patient with poorly controlled insulin-dependent diabetes presented with acute abdominal symptoms.
• Initial assessment suggested sigmoid volvulus based on abdominal X-ray findings.

Observation:

• The patient exhibited a tense, distended abdomen, severe pain, and leg numbness.
• Respiratory compromise delayed diagnostic CT scans, which provisionally indicated sigmoid volvulus.

Findings:

• Emergency laparotomy revealed a massively distended stomach occupying most of the abdominal cavity, without mechanical obstruction.
• Gastrotomy successfully decompressed the stomach, but postoperative massive hematemesis occurred, presumed to be gastric mucosal sloughing.

Implications:

• This case highlights the critical importance of considering gastric dilatation as a differential diagnosis in acute abdominal presentations, especially in diabetic patients.
• Delayed diagnosis and management of gastric dilatation can lead to severe complications, including mucosal compromise and mortality.
• Accurate and timely imaging, such as CT, is crucial for differentiating gastric dilatation from other causes of acute abdomen like sigmoid volvulus.