Gastric dilatation

Acute gastric dilatation is a common occurrence after multiple trauma. Gastric dilatation is the result of increased aerophagia due to agitation or pain, reflex gastric ileus by visceral and somatic nerve stimulation, or intubation or ventilatory problems. It may lead to vomiting, aspiration with subsequent pneumonia, and shock. Physical examination, ultrasound investigation, and diagnostic peritoneal lavage are hindered by gastric dilatation, and should be postponed until a nasogastric tube is inserted. The use of muscle relaxants at intubation can provoke esophageal reflux; this should be foreseen, and the cervical esophagus should be compressed manually (Sellick maneuver).

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