Gastric rupture caused by acute gastric distention in non-neonatal children: clinical analysis of 3 cases

To study gastric rupture, a progressive, rapid and high mortality condition, caused by acute gastric distention (GRAGD) and its appropriate diagnosis and treatment Methods The etiology, pathology, clinical manifestations and experiences in 3 children with GRAGD were reviewed Results Case 1: After diagnosising GRAGD and stabilizing her shock with massive fluid replacement, gastrostomy was performed Her postoperative course was uneventful because of fasting, suction, fluid infusion, correction of acidosis and supporting nutrition Case 2: After diagnosising gastric distention which subsided with conservative therapy for 9 days, she suddenly had gastric rupture when she had not eaten for 6 days She died of shock and had no chance for surgery Case 3: The patient had sudden abdominal pain, distention and vomitting with severe shock for 4 days Emergency surgery found gastric rupture and the method was the same as Case 1 The patient survived but has brain impairment Case 1 and 3 showed multifocal transmural necrosis Conclusions Symptoms like overeating, bulimia, changes in kind of food, X ray showing large distended stomach and massive pneumoperitoneum were seen after gastric rupture and can help to diagnose this condition Clinical course of gastric distention with toxic shock progresses rapidly, however subsequent gastric rupture exacerbates the shock and makes the treatment difficult treatment It is extremely important that a laparotomy be performed at once after stabilizing shock with massive fluid replacement Postoperative nutritional support and fluid replacement will increase survival It is very important that when gastric distention disappears after conservative therapy, the doctor should assess carefully whether the gastric wall recovery is under way by using effective methods of examination

Effect of acupuncture at three different acupoints on electrical activity of gastric distention-affected neurons in rat medial vestibular nucleus

OBJECTIVE: To observe the effect of gastric distention(GD) and acupuncture at three different acupoints on the spontaneous discharge of neurons in the medial vestibular nucleus(MVN), and to clarify the specific function of the MVN in the central integration mechanism underlying acupuncture regulation.METHODS: GD was conducted using a balloon inserted in the stomach cavity, and acupuncture was performed separately at each of three acupoints:Zusanli(ST 36), Quchi(LI 11), and Weishu(BL 21).The effect of acupuncture and GD on the spontaneous discharge of MVN neurons was assessed using a glass microelectrode filled with a sodium acetate electrolyte solution containing 1% pontamine sky blue; the discharge signals from the neurons were amplified by the microelectrode amplifier and recorded in the Spike2 system.RESULTS: GD and acupuncture significantly affected the spontaneous discharge of MVN neurons. Furthermore, acupuncture at Zusanli(ST 36) and Weishu(BL 21) was significantly more effective at altering the discharge of GD-responsive MVN neurons compared with GD-nonresponsive neurons.CONCLUSION: GD and acupuncture at three different acupoints affected the electrical activity of MVN neurons. The MVN is involved in the central integration mechanism underlying acupuncture regulation of gastric functions. The effects of acupuncture on gastric function may therefore be mediated via these particular MVN neurons.