The acute form of gastric dilatation was described by Fagge in 1872, the chief symptoms being excessive vomiting and anuria, and the disease proving fatal within three days, the dilatation being enormous. For a condition occurring as rapidly and progressively as this does there is as yet no satisfactory explanation, careful autopsy failing to disclose a sufficient reason. It has been known in at least twelve instances to follow surgical operation, four only of which were upon the abdomen, and none of them upon the stomach proper, in all instances the patients apparently progressing favorably. The stomach becomes rapidly and enormously distended, and bent upon itself with a sharp kink in the lesser curvature. Thus it seems to occupy the entire upper abdomen. Two factors at least seem to assist in the condition: A paresis of the gastric musculature, and the fact that as it becomes distended it itself produces obstruction of the duodenum, and thus aggravates the primary condition.

It has been suggested that these acute cases of postoperative dilatation are closely connected with certain cases of ileus and obstruction after abdominal operations, the dilatation once initiated tending to more and more obstruct the duodenum, as well as cause upward pressure on the diaphragm and embarrassment of the heart’s action. Hence the value of the stomach tube in treatment of such conditions.

Symptoms.

—The symptoms are usually sudden and fulminating, beginning with intense pain, which finally involves the entire abdomen. Vomiting comes early and persists, the vomited fluid being greenish in color and large in amount, changing later to a brownish color and having an offensive odor. The act of vomiting is passive rather than active or violent. In spite of it the stomach never seems to empty itself. The outline of the dilated stomach may be seen through the abdominal wall, bulging being often extreme. With the passage of the stomach tube there may be escape of a large amount of gas as well as of fluid. Thirst is intolerable and never satisfied. The amount of urine is almost always reduced and sometimes anuria is practically complete.

Treatment.

—The treatment is too often ineffectual, since the condition itself is lethal almost from the beginning. Early and frequent lavage, or perhaps leaving the stomach tube in place, would be indicated. It might be practicable to pass a small tube through the nostril and leave it, as is done with the insane. Gastrostomy would be theoretically indicated, could it be done sufficiently early. The same is perhaps true of gastro-enterostomy, although it has never had a fair trial, these cases coming to the surgeon too late to permit of much help.

Chronic Dilatation of the Stomach.

—Chronic dilatation of the stomach, often spoken of as gastrectasis, is a frequent complication of various other conditions, being essentially a consequence rather than a primary condition. It may be due to:

1. Pyloric stenosis or its equivalent in the first part of the duodenum: