Intestinal Problems - Vomitoma / Hemorrhoidal Anal Suffering - Vomitoma / HAS split tape (Cassette)
Immunosuppression, diabetes mellitus, ingestion of corrosive substances, alcoholism, and nonsteroidal anti-inflammatory drugs ingestion are common predisposing factors. Affected patients are very ill with severe abdominal pain, peritoneal signs, and elevated WBCs, often resulting in a fulminant clinical course, shock, and a high rate of mortality [ 910 ].
Unlike emphysematous gastritis, GE is noninfectious in origin and occurs primarily due to entry of intraluminal air into the wall of the stomach. It may be divided into three etiological categories: traumatic, obstructive, and pulmonary [ 1 ]. Traumatic GE is caused by transmural diffusion of air after a mucosal injury, which can occur during esophagogastroduodenoscopy EGDsevere vomiting, cardiopulmonary resuscitation CPRIntestinal Problems - Vomitoma / Hemorrhoidal Anal Suffering - Vomitoma / HAS split tape (Cassette) acute gastric dilatation caused by eating disorders [ 2 — 4611 ].
Obstructive GE has been reported in patients with gastric outlet obstruction due to a variety of conditions. The increase in the intragastric pressure accompanied by damaged gastric mucosa permits the entry of air into the wall of the stomach. Gastric carcinoma, gastric volvulus, duodenal obstruction, and hypertrophic pyloric stenosis in children have been reported as causes of obstructive GE [ 15 ]. Pulmonary GE is caused by alveolar rupture and air leaks, which then track through the mediastinum and dissecting downwards to reach the stomach wall [ 1 ].
Clinical manifestations in GE are usually nonspecific. Patients may present with nausea, vomiting, epigastric discomfort, or abdominal pain. Importantly, patients are almost always hemodynamically stable and do not show signs of acute abdomen. In general, it has a benign clinical course and resolves spontaneously without any clinical sequel [ 1 — 46 ]. HPVG was frequently seen with bowel necrosis, small bowel obstruction, peptic ulcer disease, and intra-abdominal abscess [ 7 ].
Hence presence of gas in the portal venous system was often considered to represent an intra-abdominal catastrophic event. However, with advances in imaging techniques and increasing availability of CT scans, many benign cases of HPVG have been found. Ulcerative colitis, barium enemas, colonoscopy, liver transplantation, GE, and cardiopulmonary resuscitation represent such benign causes of HPVG.
Conservative treatment is successful in many of these cases without surgical intervention [ 781213 ]. Hussain et al. First, patients with HPVG and signs of acute abdomen are best treated with emergent surgery. Second, patients with HPVG who lack clinical signs and demonstrate stable hemodynamic parameters should receive conservative management. We believe that, in our case, repeated episodes of vomiting and retching caused damage to the gastric mucosa and sudden increase in the intragastric pressure.
This led to dissection and leaking of air into the intramural layer of the stomach wall and subsequent spread to the portal veins, superior mesenteric vein, and splenic vein Figure 1. Because the patient presented with benign physical exam and laboratory findings, a conservative treatment approach was chosen. Clinical improvement and spontaneous resolution of air within two days as confirmed by a repeat CT scan of the abdomen Figure 2 further substantiated our theory that the etiology of visceral air was benign and not due to ischemia of the bowel or stomach.
Hence, HPVG does not always indicate serious intra-abdominal pathology. It can be associated with benign conditions as described above. Also HPVG is just a radiological sign and it should not be solely relied upon in deciding between surgical intervention and conservative treatment; rather entire clinical picture including underlying etiology, clinical examination, and laboratory parameters should be taken into consideration [ 1314 ].
The presence of air in the wall of stomach may be due to GE, which is often self-resolving, Intestinal Problems - Vomitoma / Hemorrhoidal Anal Suffering - Vomitoma / HAS split tape (Cassette) due to emphysematous gastritis, which heralds worse prognosis.
Superimposed occurrence of air in the portal venous system often causes a dilemma when considering surgical options. Historically, presence of gas in the portal venous system was considered as an acute abdominal emergency and warranted urgent surgical intervention but recently many benign causes of GE and HPVG have been described in the literature.
These new cases were not associated with serious abdominal pathology and did not require surgical intervention. Therefore, HPVG by itself should no longer be an indication for emergent surgical intervention. The authors declare that there is no conflict of interests regarding the publication of Intestinal Problems - Vomitoma / Hemorrhoidal Anal Suffering - Vomitoma / HAS split tape (Cassette) paper. Parikh et al. This is an open access article distributed under the Creative Commons Attribution Licensewhich permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Article of the Year Award: Outstanding research contributions ofas selected by our Chief Editors. Read the winning articles. Journal overview. Academic Editor: Gerald S. Received 02 Dec Accepted 02 Feb Published 11 Feb Abstract Gastric pneumatosis is the presence of air within the wall of the stomach. This is a similar way to how gastroenteritis gastro causes abdominal pain.
Another explanation for the pain is that COVID can lead to a sudden loss of blood supply to abdominal organs, such as the kidneys, resulting in tissue death infarction. In Australia, nausea, diarrhea and vomiting are listed as other COVID symptoms, alongside the classic ones which include fever, cough, sore throat and shortness of breath. But abdominal pain is not listed. Doctors often use the concept of pre-test probability when working out if someone has a particular disease.
This is the chance a person has the disease before we know the test result. Intestinal Problems - Vomitoma / Hemorrhoidal Anal Suffering - Vomitoma / HAS split tape (Cassette) makes it difficult to determine the pre-test probability for COVID is we don't know how many people in the community truly have the disease. For example, about a quarter of people at some point in their lives are known to suffer from dyspepsia discomfort or pain in the upper abdomen. As he seemed otherwise healthy before developing new abdominal symptoms, and considering he worked on a COVID wardhis pre-test probability was high.
Doctors call this a "high index of suspicion" when there is a strong possibility someone may have symptoms due to a disease such as COVID If you have new gastrointestinal symptoms and you've potentially been in contact with someone with COVID or if you also have other classic COVID symptoms fever, cough, shortness of breath and sore throat you should definitely get tested.
If you have just gastrointestinal symptoms, you may need to get tested if you're in a "hotspot" area, or work in a high-risk occupation or industry. If you have gastrointestinal symptoms alone, without any of these additional risk factors, there is no strong evidence to support testing. If you have concerns about any gastrointestinal symptoms, seeing your GP would be sensible.
Your GP will provide a balanced assessment based on your medical history and risk profile. Explore further. This article is republished from The Conversation under a Creative Commons license. Read the original article. Use this form if you have come across a typo, inaccuracy or would like to send an edit request for the content on this page. For general inquiries, please use our contact form. For general feedback, use the public comments section below please adhere to guidelines. Your feedback is important to us.
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Kristine Novak is the science editor for Gastroenterology and Clinical Gastroenterology and Hepatology, both published by the American Gastroenterological Association. She has worked as an editor at biomedical research journals and as a science writer for more than 12 years, covering advances in gastroenterology, hepatology, cancer, immunology, biotechnology, molecular genetics, and clinical trials.
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