Acute gastric dilation: a modern view of etiopathogenesis, diagnosis, and treatment (literature review and analysis of clinical cases)

Background. Acute gastric dilatation (AGD) is a life-threatening condition that has been studied for nearly two centuries, yet it is frequently diagnosed with delay due to the subtlety of early clinical signs and their frequent misattribution to postoperative status.
Aim. To summarize the historical evolution of concepts regarding the etiopathogenesis of AGD and to analyze the authors' own clinical observations in order to clarify current diagnostic and therapeutic approaches.
Material and Methods. Domestic and international publications from 1842 to 2023 were analyzed (eLibrary, PubMed, Cyberleninka, and JAMA Network databases), including the historical works of Rokitansky, Mondor, and Samarin. Three of the authors' own clinical cases illustrating different clinical courses of AGD are presented.
Results. Three historical stages in understanding AGD etiology were identified: the anatomical stage (mechanical duodenal compression, per Rokitansky), the reflex stage (neurovegetative paralysis of the intestinal wall, per Mondor), and the systemic stage (multiple organ dysfunction, per Zilber). Contemporary AGD etiology is shown to be multifactorial, encompassing mechanical, neurogenic, metabolic, and alimentary causes. The diagnostic value of CT for detecting early signs of gastric wall ischemia (pneumatosis, hepatic portal venous gas) is demonstrated, and treatment strategy is substantiated — ranging from nasogastric decompression with a large-bore tube to emergency surgical intervention.
Conclusion. Despite advances in imaging, clinical vigilance and early gastric decompression remain the cornerstone of timely AGD diagnosis. Establishing an international registry of clinical cases could substantially expand knowledge of this condition through systematic documentation.

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