Acute gastric dilatation with segmented abdominal paresis as a rare manifestation of herpes zoster: a case report and review of the literature.

BACKGROUND: Herpes zoster is a common disease that can affect men and women at any age. Sensory neuropathy is the most common complication while motor neuropathy of the abdominal muscles is rare complication appearing in ~ 0.7% of patients. Furthermore, visceral nerve involvement causing gastroparesis is an extremely rare postherpetic complication. We present an extremely rare case of acute gastric dilatation with segmented abdominal paresis as a rare manifestation of herpes zoster infection. CASE PRESENTATION: A 91-year-old Asian man was admitted to hospital with 2-day history of vomiting and left abdominal protrusion. He was previously treated for a rash on the left abdominal wall as herpes zoster infection with oral valaciclovir 2 weeks prior. On physical examination, characteristic herpes zoster rash scars and an ipsilateral abdominal bulge were observed on the left side. Computed tomography revealed no abdominal wall defect, mass, or stenosis. Remarkable distension of the stomach, asymmetrical left flank wall bulge, and a thinner abdominal wall on the left compared with the right side were shown. He was diagnosed as acute gastric dilatation owing to gastroparesis and segmental paresis of the abdominal musculature associated with herpes zoster infection. The patient showed significant improvement in symptoms and abdominal paresis within a month of conservative treatment, including nasogastric tube decompression and mosapride administration. CONCLUSION: Acute gastric dilatation with abdominal paresis is an extremely rare complication of herpes zoster infection, and to date there have been no reports in the literature. It alerts us that, when examining patients with abdominal bulge, we should be conscious of this rare pathology for the optical diagnosis, avoiding unnecessary invasive examination or surgical exploration.

Radiological and laboratory prognostic parameters for gastric dilation in rabbits (Oryctolagus cuniculus).

BACKGROUND: The aim of this study was to evaluate the radiographical and laboratory findings in pet rabbits with gastric dilation (GD) and identify prognostic parameters. METHODS: One hundred and fifty-five rabbits with GD were included for the radiographical analyses and 75 for the laboratory analyses. A vertebral stomach score (VSS) was established to determine the extension of the stomach on lateral radiographs. In addition, the caudal limit of gastric distention and the extension and position of gas accumulation in the stomach were recorded. RESULTS: The VSS was significantly higher in rabbits with GD than in healthy rabbits (p = 0.001). Extensive amounts of gas accumulation in the stomach (p = 0.001) and a ventral or central location of gas accumulation (p = 0.023) were associated with significantly increased mortality. Azotemia (51%), hyperglycaemia (44%) and hyponatraemia (37%) were the most frequent biochemical alterations in rabbits with GD. LIMITATIONS: Due to the retrospective nature of the data, the cause of GD could not be determined in all animals. CONCLUSION: Rabbits with GD and severe alterations in glucose, creatinine and sodium concentrations, ventral or central gas accumulations and a large amount of gas in the stomach had a poor prognosis.

Left medial liver lobe torsion and postoperative acute gastric rupture in a 2.5-year-old male-castrated Flemish Giant rabbit (Oryctolagus cuniculus).

A 2.5-year-old male-castrated rabbit presented with acute abdominal pain, lethargy, and anorexia. Digital radiography revealed increased left-sided hepatomegaly, gastric dilation, and decreased peritoneal serosal detail. Abdominal ultrasonography identified a torsed left liver lobe, gastric dilation, and peritoneal effusion. Surgery confirmed a left medial liver lobe torsion, with subsequent lobectomy and seven days of hospitalization. The patient re-presented 2 days after discharge and suddenly died while hospitalized, with acute gastric rupture, fulminant peritonitis, and multifocal hepatic infarcts diagnosed on necropsy. We believe this is the first recorded imaging diagnosis of a left medial liver lobe torsion in a rabbit.

Clostridium ventriculi in a cynomolgus monkey with acute gastric dilatation and rupture: A case report.

Acute gastric dilatation (AGD) is one of the most prevalent and life-threatening diseases in nonhuman primates worldwide. However, the etiology of this syndrome has not been determined. Recently, sudden death occurred in a 7-year-old female cynomolgus monkey with a history of fecal microbiota transplantation using diarrheic stools. The monkey had undergone surgery previously. On necropsy, gastric dilatation and rupture demonstrated a tetrad arrangement on histopathologic examination. On 16S rRNA sequencing, a high population of Clostridium ventriculi was identified in the duodenum adjacent to stomach but not in the colon. This paper is the first report of Clostridium ventriculi infection in a cynomolgus macaque with acute gastric dilatation and rupture.

Outcomes and complications of prophylactic incisional gastropexy in 766 dogs (2009-2019).

OBJECTIVE: To report the outcomes and complications associated with prophylactic incisional gastropexy performed in dog breeds at risk for GDV. RESULTS: Seven hundred and sixty-six dogs underwent prophylactic incisional gastropexy of which 61 were electively performed at the time of castration or spay and 705 were adjunctively performed at the time of emergency abdominal surgery. All dogs had short-term follow-up, and 446 dogs (58.2%) had additional follow-up with a median long-term follow-up time of 876 days (range 58-4450). Only 3 dogs (0.4%) had a direct complication associated with the gastropexy site including hemorrhage causing hemoabdomen (2) and infection with partial dehiscence (1). No dogs with long-term follow-up experienced gastric dilatation (GD), gastric dilatation volvulus (GDV), or persistent GI signs following gastropexy. Results of this study found that complications directly associated with prophylactic gastropexy were rare and limited to hemorrhage causing hemoabdomen and infection with partial dehiscence. Transient postoperative GI signs may occur. Gastropexy malpositioning and bowel entrapment were not encountered. There was no occurrence of GD or GDV.

Sarcina sp. as a presumptive cause of fatal acute gastric dilation and gastric emphysema in rhesus macaques.

A 4-y-old female and 3-y-old male rhesus macaque (Macaca mulatta), both housed in the same facility, died unexpectedly within 2 wk. Postmortem examination revealed severe gastric dilation in both macaques and gastric emphysema in the female macaque. Histologically, bacteria consistent with Sarcina sp. were present in both macaques within the lungs and lumen of the trachea, esophagus, and gastrointestinal (GI) tract without associated inflammation. Additionally, in the female macaque, the bacteria were found in the gastric mucosa and associated with emphysematous spaces in the gastric wall without associated inflammation. PCR and Sanger sequencing of amplicons were subsequently performed on GI contents and non-alimentary tissues from the 2 affected monkeys and on comparative samples from unaffected rhesus monkeys in the same facility and an adjacent primate facility. The cases were compared using the 2-tailed Fisher exact test (p-value at 95% confidence). PCR identified Sarcina in GI contents of both affected and unaffected monkeys (p = 0.6084) and in non-alimentary tissues of affected monkeys only (p = 0.0083). These results suggest that the presence of Sarcina sp. in non-alimentary tissues is associated with gastric distension, gas accumulation, and unexpected death in nonhuman primates.

Perioperative characteristics and long-term outcomes following prophylactic total laparoscopic gastropexy using a novel knotless tissue control device in 44 dogs.

Objective: To report on operative technique and outcomes following prophylactic total laparoscopic gastropexy (PTLG) using a novel knotless tissue control device (KTCD) in dogs. Animals: This study included 44 dogs. Procedure: Medical records were reviewed, and perioperative data were collected. Right-sided incisional gastropexy was performed using 2 strands of KTCD introduced through a 12-millimeter cannula in a single-incision multi-channeled port. Dog owners were contacted to obtain outcome data. Results: Median age and weight of dogs were 17 mo (6 to 60 mo) and 48.5 kg (14 to 73.3 kg). Median surgical and anesthesia times were 90 min (60 to 150 min) and 195 min (135 to 270 min). Major intraoperative complications were not reported. Follow-up data were available for 40/44 (91%) dogs. Median follow-up time was 522 d (43 to 983 d). Gastric dilatation volvulus (GDV) was not reported in any dog. One dog developed suspected colonic entrapment around the gastropexy that required surgical revision. All owners were satisfied with the procedure and indicated they would repeat the procedure with future pets. Conclusion: The PTLG procedure using novel KTCD in this cohort of dogs was effective at preventing GDV for the duration of follow-up and was associated with low perioperative complication rate and high owner satisfaction. Clinical relevance: This retrospective study reports on operative technique and outcomes associated with KTCD use in PTLG. Our findings warrant prospective evaluation of KTCD use in PTLG.

Caractéristiques peropératoires et résultats à long terme après une gastropexie laparoscopique totale prophylactique à l'aide d'un nouveau dispositif de contrôle des tissus sans nœuds chez 44 chiens. Objectif: Rendre compte de la technique opératoire et des résultats après une gastropexie laparoscopique totale prophylactique (PTLG) à l'aide d'un nouveau dispositif de contrôle des tissus sans nœuds (KTCD) chez le chien. Animaux: Cette étude a inclus 44 chiens. Procédure: Les dossiers médicaux ont été examinés et les données peropératoires ont été recueillies. La gastropexie incisionnelle du côté droit a été réalisée à l'aide de 2 brins de KTCD introduits par une canule de 12 millimètres dans un orifice multicanal à incision unique. Les propriétaires de chiens ont été contactés pour obtenir des données sur les résultats. Résultats: L'âge et le poids médians des chiens étaient de 17 mois (6 à 60 mois) et 48,5 kg (14 à 73,3 kg). Les temps chirurgicaux et anesthésiques médians étaient de 90 min (60 à 150 min) et 195 min (135 à 270 min). Des complications peropératoires majeures n'ont pas été rapportées. Des données de suivi étaient disponibles pour 40/44 (91 %) chiens. La durée médiane de suivi était de 522 jours (43 à 983 jours). Le volvulus de dilatation gastrique (GDV) n'a été signalé chez aucun chien. Un chien a développé une suspicion de piégeage du côlon autour de la gastropexie qui a nécessité une reprise chirurgicale. Tous les propriétaires étaient satisfaits de la procédure et ont indiqué qu'ils répéteraient la procédure avec de futurs animaux de compagnie. Conclusion: La procédure PTLG utilisant le nouveau KTCD dans cette cohorte de chiens a été efficace pour prévenir le GDV pendant la durée du suivi et a été associée à un faible taux de complications peropératoires et à une satisfaction élevée des propriétaires. Pertinence clinique: Cette étude rétrospective rend compte de la technique opératoire et des résultats associés à l'utilisation de KTCD dans le PTLG. Nos résultats justifient une évaluation prospective de l'utilisation de KTCD dans le PTLG.(Traduit par Dr Serge Messier).

Abdominal compartment syndrome caused by severe acute gastric distension in a patient with COVID-19: A case report.

RATIONALE: The clinical manifestation of coronavirus disease 2019 (COVID-19) ranges from asymptomatic to critical. The gastrointestinal (GI) tract is involved in the early stages of the disease and is recognized as an important entry site for the virus. Consequently, GI manifestations are common in patients with COVID-19; however, the GI presentation of COVID-19 in relation to bowel dilatation has rarely been reported. Here, we report a case of acute severe gastric distension resulting in aortic compression and abdominal compartment syndrome (ACS) in a patient with COVID-19. PATIENT CONCERNS: A 72-year-old male presented to the emergency department (ED) with severe abdominal distension. The patient had been confirmed to have COVID-19 5 days prior to the visit. DIAGNOSES: Computed tomography revealed critical abdominal distension with severe gastric dilatation, accompanied by compression of the abdominal aorta and distal thrombosis formation. INTERVENTIONS: Intravenous fluid resuscitation and support with inotropic agents were initiated immediately, and a large amount of gastric content was evacuated via a nasogastric (NG) tube. OUTCOME: Finally, the patient was discharged after 12 days of admission without obvious complications. LESSONS: ACS is critical, which can be caused by a severe degree of acute gastric distension (AGD). Evacuation of the intraluminal contents is the most efficient management strategy. Prognosis is poor, and most previous studies of the transition from AGD to ACS have reported unfavorable outcomes.

Comparison of incisional gastropexy with and without addition of two full-thickness stomach to body wall sutures.

OBJECTIVE: To compare complications between a modified incisional gastropexy (MIG) technique and standard incisional gastropexy (SIG). ANIMALS: 347 client-owned dogs. PROCEDURES: Dogs that had undergone SIG or MIG from March 2005 through April 2019 were identified through a medical record search of the University of Missouri Veterinary Health Center. The MIG technique is identical to SIG except 2 additional simple interrupted sutures are added, 1 cranial and 1 caudal to the continuous suture line, going full thickness into the stomach to ensure engagement of submucosa. Medical record information was used to identify intraoperative, postoperative, and short-term complications, and telephone or email communication to pet owners and/or referring veterinarians was used to identify complications (short-term and long-term) after discontinuance of care at the University of Missouri Veterinary Health Center. Intraoperative, postoperative, short-term, and long-term complications were analyzed in aggregate within 6 matched groupings: (1) gastropexy for gastric dilatation-volvulus, (2) prophylactic gastropexy without other procedures, (3) gastropexy with ovariohysterectomy, (4) gastropexy with castration, (5) gastropexy with splenectomy, and (6) gastropexy with celiotomy other than splenectomy. Overall rates of complications potentially attributed to gastropexy were compared between SIG and MIG using the Fisher exact test. Overall rates of complications not attributed to gastropexy were compared between SIG and MIG using the χ2 test. RESULTS: There were no significant differences in overall complication rates between SIG and MIG. CLINICAL RELEVANCE: Surgeons who feel that engagement of gastric submucosa is important for gastropexy success may use the MIG technique with minimal fear of complications. However, superiority of one technique over the other cannot be determined on the basis of this study.

A healthy young patient with hepatic portal vein gas due to acute gastric dilatation: a case report.

Hepatic portal vein gas (HPVG) is caused by the influx of gastrointestinal gas into the intrahepatic portal vein as a result of gastrointestinal wall fragility due to ischemia or necrosis. Gastrointestinal tract necrosis is fatal in severe cases. We observed a case of food intake-induced acute gastric dilatation (AGD) in a healthy young male who developed HPVG and underwent conservative treatment. A 25-year-old male presented to our hospital with epigastric pain and nausea the day after excessive food intake. Computed tomography (CT) revealed gas along the intrahepatic portal vein and marked gastric dilatation with large food residue. AGD-induced HPVG was considered. Esophagogastroduodenoscopy (EGD) was not performed at this stage because of the risk of HPVG and AGD exacerbation, and the patient was followed up with intragastric decompression via a nasogastric tube. Food residue and approximately 2 L of liquid without blood were vomited 1 h after the nasogastric tube placement. His symptoms improved after the vomiting episode. An EGD was performed 2 days after undergoing CT. Endoscopic findings revealed extensive erosions and the presence of a whitish coat extending from the fornix to the lower body of the stomach, indicating AGD. HPVG disappeared on the CT scan taken during EGD. Thereafter, symptom relapse and HPVG recurrence were not observed.

FATAL GASTRIC DILATATION AND VOLVULUS IN THREE CAPTIVE JUVENILE LINNAEUS'S TWO-TOED SLOTHS (CHOLOEPUS DIDACTYLUS).

Linnaeus's two-toed sloth (Choloepus didactylus) is one of two extant neotropical species of the family Megalonychidae. Despite their being commonly kept under managed care, the digestive physiology of sloths remains poorly understood. Gastrointestinal disease has been reported as a primary or contributing cause of morbidity and mortality in captive two-toed and three-toed (Bradypus spp.) sloths. Gastric dilatation due to gas accumulation ("bloat") has been reported in sloths; however, a literature search failed to yield any published mention of gastric volvulus in any sloth species. Following an inquiry sent to the electronic mailing lists of the American Association of Zoo Veterinarians, the European Association of Zoo and Wildlife Veterinarians, and the LatinVets community, three cases of fatal gastric dilatation and volvulus (GDV) were identified in one male and two female Linnaeus's two-toed sloths from institutions in the United States, Canada, and Germany. All cases occurred in juvenile sloths <1 yr of age. Two animals were primarily hand reared, whereas one was reared primarily by its dam. Two animals were found dead with no overt premonitory signs, whereas one animal died following a 3-wk course of waxing and waning clinical signs consistent with gastric gas accumulation. In all cases, GDV was diagnosed on postmortem examination. Similar to other species, the condition is likely subsequent to a combination of host- and husbandry-related contributing factors. Further research into sloth husbandry is required in order to take an evidence-based approach to their management.

An atypical gastric duplication cyst as a rare cause of gastric dilatation: the key role of the endoscopy ultrasound.

We have written a "letter to Editor" about a case of gastric dilatation caused by a symptomatic gastric duplication cyst with ectopic pancreas ingrowth, in a 13 years old boy. The Endoscopy Ultra Sound characterized the lesion and permitted the aspiration of the internal liquid. The patient underwent to laparoscopic excision of the mass and the histology revealed a gastric duplication cyst with ectopic pancreas ingrowth.