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Case report
Acute massive gastric dilatation: a rare, forgotten complication of fundoplication
  1. Sue Een Lau1,
  2. Tristan Boam2,3,
  3. Simon Parsons4 and
  4. Sandeep Motiwale3
  1. 1University of Nottingham Medical School, Queen's Medical Centre, Nottingham, UK
  2. 2Department of Paediatric Surgery, Norfolk and Norwich University Hospital NHS Trust, Norwich, UK
  3. 3Department of Paediatric Surgery, Nottingham University Hospital NHS Trust, Nottingham, UK
  4. 4Department of General Surgery, Nottingham University Hospital NHS Trust, Nottingham, UK
  1. Correspondence to Sue Een Lau; sueeen.lau{at}nhs.net

Abstract

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.

  • paediatric surgery
  • gastrointestinal surgery
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Footnotes

  • SEL and TB are joint first authors.

  • SEL and TB contributed equally.

  • Contributors SEL: involved in writing the article and literature review. TB: involved in writing the article, literature review and management of case. SM and SP: involved in editing the article and were the operating surgeons.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Parental/guardian consent obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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