Dilatația acută de stomac la copil – prezentare de caz clinic

Abstract

Introducere. Dilatația acuta de stomac rămâne o provocare in practica chirurgiei pediatrice, din cauza rarității patologiei date si a complicațiilor ca necroza masiva a peretelui gastric. Etiologie: anorexie nervoasa, bulimie, polifagia psihogena, traumatisme diverse etc. Clasic se întâlnește in psihiatrie la pacienții cu tulburări alimentare. Caz clinic. Copil de 4 ani, sex masculin, din anamneză cu semne de autism si dereglări psihogene de tulburări alimentare cu litofagie, s-a prezentat in serviciu de primire urgentă pe 07.05.2016, într-o stare extrem de gravă și a fost internat în secția de reanimare chirurgicala a CNSP „Natalia Gheorghiu”. La internare copilul prezenta agitație, vome multiple cu conținut alimentar, dureri abdominale intense, oprirea tranzitului intestinal de 48 ore. Obiectiv: t=38,9°C, abdomenul balonat cu timpanism percutor in epigastru, dureros la palpare superficiala si profundă, semnele peritoneale – negative. La tușeu rectal – fără formațiuni patologice, pe mănușa urme de scaun fără mucus si sânge. La efectuarea radiografiei pe gol a cavitații abdominale s-a depistat un stomac dilatat, mici nivele hidroaerice intestinale. La USG organelor cavitații abdominale s-a vizualizat stomacul mărit in dimensiuni cu conținut lichid in cantitate mare, ansele intestinale - cu peristaltica. Indicii de laborator: Lc -10,8, in urina – corpi cetonici +++. In dinamica a fost exclus diagnosticul inițial de ocluzie intestinala, apendicita acuta. S-a presupus cel de Dilatație acuta de stomac, litobezoar ? Imediat a fost aplicata sonda nazo-gastrica cu scop de decompresie. S-au corectat dereglările hidro-electrolitice. Tratamentul conservator s-a adeverit de succes, astfel intervenția chirurgicala nefiind necesara.

Introduction. Acute gastric dilatation (AGD) is a rare event and is a provocation in pediatric surgery. AGD is encountered most often in a multitude disorders, such as anorexia and bulimia nervosa, psychogenic polyphagia, trauma, etc. Psychogenic disturbances with abnormal eating habits have been also stressed as important etiological factors in precipitating AGD. Case report. A 4 year-old boy presented to the emergency department NSPC of Pediatric Surgery „Natalia Gheorghiu” 07.05.2016, hospitalized in intensive care, reporting acute abdominal pain and distended abdomen. He had persistent vomiting. Psychiatric assessment revealed a borderline retarded child with autism. He is diagnosed as having a typical eating disorder (lithofagie). The patient was in discomfort and distress. On physical examination, he had a body temperature of 38,2 C, the abdomen was massively distended, with tenderness to palpation. A generalized tympani was elicited and bowel sounds were absent, constipation more 48 hour. Rectal examination revealed no pain, normal stool was present in the rectal ampulla with no blood traces.In the emergency department, a complete blood count revealed a leukocytosis of 10,8x103/mm3. A plain abdominal film showed a fluid level in a markedly distended stomach, no free air in the peritoneal cavity and no bowel levels were identified. Ultrasound of the abdominal cavity showed a massive gastric dilatation and intestinal peristaltisme were present. It was excluded diagnosis of intestinal obstruction, acute appendicitis. Acute gastric dilatation was established. A nasogastric tube was placed immediately and intravenous fluid replacement was immediately started. Conservative treatment was successful. Conclusion. Prompt diagnosis of acute gastric dilatation and decompression of the stomach may avoid unnecessary laparotomy.