Gastric distension is an uncomfortable inflation of the stomach caused by gas. This can occur when a patient is not properly ventilated during cardiopulmonary resuscitation (CPR) or medical procedures, or as a complication of procedures where gas is introduced into the abdomen. In some cases, it can be the result of overeating, seen in people with some eating disorders and conditions like Prader-Willi syndrome. These patients may lack the checks that normally curb unsafe food intake.
Classically, gastric distension can occur when someone performs CPR and air travels down the esophagus instead of the trachea, causing the stomach to fill with air. Tilting the head back can reduce the chance of this, as can paying attention to signs that air is entering the stomach and not the lungs. There are two concerns with gastric distension in this case. The patient may not be getting enough oxygen, or the stomach contents could push into the lungs and cause an infection.
Similar gastric distension can be seen when endotracheal tubes are not placed correctly and air from a mechanical ventilator or hand-held bag is pushed into the stomach. Care providers need to pull the tube back and reinsert it to protect the patient. To empty the stomach safely, patients can be placed on their sides while gentle pressure is applied to the stomach to encourage the air to vent. If the patient vomits, it will be more likely to flow out the mouth than into the lungs in this position.
Some surgeries involve pumping carbon dioxide into the abdomen to inflate it, making the contents easier for the surgeon to see. This is common with endoscopic surgery, where the care provider enters through small incisions. The contents of the abdomen can be difficult to navigate when it’s hard to see, and gas inflation pushes them apart to allow the surgeon to clearly visualize the contents. Sometimes poor placement results in gas leaks into the stomach, particularly in procedures involving the stomach, intestines, or trachea.
Another potential concern is gastric dilation, which goes beyond gastric distension. It includes a mixture of food and gas which the patient may not be able to digest. The inflated stomach presses against the diaphragm, which can make it hard to breathe. If the patient eats too much, the stomach can actually rupture, creating a life-threatening medical emergency. Normally, gastric distension triggers the brain to tell the body to stop eating, but in some patients, the safety mechanism isn’t functional, and they may eat to the point of rupture.