Can Stomach Dilate?

Can our stomach dilate? The answer is yes! There can be a sudden loss of sympathetic tone resulting in the acute or chronic massive dilation of the stomach cavity (also called gastrectasia). This results in retention of food and other digestive products in the stomach for a long period. The capacity of the stomach may exceeds 50 ounces.

Acute dilation of stomach can occur after any surgery (particularly splenectomy and other pelvic procedures), fractures (femur and spine), malnutrition, excessive distention of stomach, aerophagia and allowing oral fluids early after paralytic ileus. Usually a history of some surgery is often present. There may even be sudden loss of sympathetic tone.

The early symptoms depend upon the cause of dilation. Symptoms include hiccoughs (due to irritation of the diaphragm by the huge stomach), pain in abdomen, nausea, vomiting, distention and increasing size of stomach. Increased hunger and thirst are marked features. Coated tongue, fetid breath, emaciation and dry skin are also observed.

There is characteristic effortless vomiting of dark fluid (foul smelling, sour) and blood. The amount of the vomitus is in litres and occurs at a gap of every 2-3 days. Vomitus separates into three layers on standing (brown, yellow and cloudy). The massive amount of vomiting leads to shock, which if left untreated may lead to cardio vascular collapse.

On examination, pulse rate is rises slowly and urine output falls considerably. The dilated stomach may even reach the pelvis. There is a noticeable bulge over the left side of the abdomen, epigastrium and sometimes over the right region also. The dilatation of the stomach may produce cardiac troubles such as palpitations and dyspnoea.

Treatment includes immediate aspiration of stomach and rapid fluid replacement. Treating the shock is also necessary. However, aspiration may sometimes lead to aspiration pneumonia in debilitated persons.

Prognosis is usually unfavourable and significant mortality rate is seen.