University of Nottingham Medical School, Queen's Medical Centre, Nottingham, UK
Department of Paediatric Surgery, Norfolk and Norwich University Hospital NHS Trust, Norwich, UK.
BMJ Case Rep. 2020 May 27;13(5):e232479. doi: 10.1136/bcr-2019-232479.
An 8-year-old boy with a history of multiple neonatal laparotomies, including congenital diaphragmatic hernia repair and an open fundoplication, presented acutely with severe abdominal pain, distension, vomiting and shock. A large abnormal opacity in the left upper quadrant was visible on a plain abdominal radiograph. The patient was taken to the theatre for emergency laparotomy and was found to have a massively distended stomach, the fundus and body of which were necrotic. A subtotal gastrectomy was performed, sparing the viable tissue. The patient went on to make a full recovery. Acute massive gastric dilatation (AMGD) is a rare condition characterised by severe gastric distension. Gastric ischaemia results when intragastric pressure exceeds venous pressure, obstructing venous outflow. It is important to recognise AMGD as a severe complication of fundoplication due to closed-loop gastric obstruction. It should prompt consideration of an early laparotomy in cases where the diagnosis is suspected.
一位 8 岁男孩，既往有多次新生儿剖腹探查术史，包括先天性膈疝修补术和开放性胃底折叠术，此次因严重腹痛、腹胀、呕吐和休克而急性发作。腹部平片可见左上象限有一大片异常不透光影。患者被送往手术室行急诊剖腹探查术，发现胃极度扩张，胃底和胃体坏死。行胃次全切除术，保留有活力的组织。患者完全康复。急性胃扩张（AMGD）是一种罕见的疾病，其特征为胃严重扩张。当胃内压超过静脉压时，会导致胃静脉回流受阻，引起胃缺血。由于闭襻性胃梗阻，将 AMGD 视为胃底折叠术的严重并发症，这一点非常重要。如果怀疑诊断，应及早行剖腹探查术。
