Gastric bazuqueo

Specialty: Gastrointestinal.

• Gastric splash
• audible gastric succussion
• gastric retention splash

Why it occurs

• Obstruction of the gastric outlet tract (pyloric stenosis secondary to scars from recurrent duodenal ulcers or adenocarcinoma of the gastric antrum)
• Severe gastroparesis of diabetic, idiopathic or post-surgical origin due to injury to the branches of the vagus nerve
• Intrinsic or extrinsic duodenal stenosis or compression (aortomesenteric clamp syndrome or Wilkie syndrome)
• Proximal jejunal mechanical obstruction due to flanges or intestinal intussusception.

Initial workup

Physical abdominal succussion maneuver (epigastric auscultation while the patient's pelvis is rocked laterally; positive if a liquid splash is heard more than 4-6 hours after the last fast) | Upper gastrointestinal endoscopy (EDA, after decompression with a large caliber nasogastric tube to avoid bronchoaspiration) | Abdominal CT with oral and intravenous contrast to define the anatomy of the pyloric area | Esophagogastroduodenal transit with water-soluble contrast to detect delayed emptying.

Standard management

• Intravenous prokinetics — metoclopramide 10 mg IV every 8 hours or erythromycin 200 mg IV slowly infused to force emptying in gastroparesis, formally contraindicated if there is complete mechanical pyloric obstruction
• Intravenous hydroelectrolyte replacement fluid therapy — 0.9% saline supplemented with potassium chloride [KCl] according to ionogram to correct metabolic alkalosis and hypokalemia
• Proton pump inhibitors (pantoprazole 40 mg IV every 12 hours to reduce basal gastric secretory volume).