Equis ISSN 2398-2977

Stomach: rupture

Contributor(s): Rachel Murray, Peter Rakestraw

Introduction

  • Gastric rupture usually occurs along greater curvature of stomach.
  • Cause: usually associated with gastric distension, eg in grass sickness, grain overload, small intestine obstruction.
  • Signs: severe pain followed by abrupt cessation of pain; endotoxic and hypovolemic shock.
  • Diagnosis: abdominocentesis, rectal palpation.
  • Treatment: immediate euthanasia   Euthanasia  . Surgery may be attempted if tear occurs during laparotomy, or in foals.
  • Prognosis: grave to hopeless.

Pathogenesis

Etiology

  • Gastric rupture usually follows gastric distension , which may be primary (affecting only the stomach) or secondary (due to a distal intestinal obstruction or ileus):
  • Grass sickness (dysautonomia)   Grass sickness  .
  • Grain overload; consumption of unsoaked sugar beet or fresh chopped grass.
  • Ileus   Gastrointestinal: ileus  secondary to distention, trauma, handling, electrolyte abnormalities, anesthesia etc.
  • Intestinal herniation, intussusception, volvulus, displacement or impaction.
  • Extension of intestinal tears.
  • Parasitism withGasterophilusspp   Stomach: gasterophilus infestation  .
  • Ulcerative gastritis   Stomach: gastric ulceration  .
  • Gastric rupture may also be idiopathic.
  • Trauma.

Predisposing factors

General
  • Gastric dilatation.

Pathophysiology

  • Usually follows gastric distension.
  • Usually follows gastric dilatation   →   severe abdominal pain   →   dramatic tachycardia   →   gastric rupture along greater curvature   →   sudden relief of pain   →   endotoxic and hypovolemic shock   →   cardiovascular collapse   →   death.

Timecourse

  • Duration of clinical signs before rupture varies from <1 hour to almost 1 month.

Epidemiology

  • Prevalence of gastric rupture 1-6% in post-mortem surveys; 5-8% in cases of colic.

Diagnosis

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Treatment

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Prevention

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Outcomes

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Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Hogan P M, Bramlage L R and Pierce S W (1995)Repair of a full-thickness gastric rupture in a horse.JAVMA207(3), 338-340 PubMed.
  • Steenhaut M, Vlaminck K and Gasthuys F (1986)Surgical repair of a partial gastric rupture in a horse.Equine Vet J18(4), 331-332 PubMed.
  • Todhunter R J, Erb H N, and Roth L (1986)Gastric rupture in horses - A review of 54 cases.Equine Vet J18(4), 288-293 PubMed.


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