Giant Stomach After Eating a Chinese Bayberry

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Abdominal X-ray revealed lots of gas in stomach. Image Source: ClinMed International Library

Giant stomach in a seventeen-month-old baby secondary to a congenital malformation and ingestion of a Chinese strawberry.

A 17-month-old boy was brought with complaints of vomiting and abdominal pain for the past 7 days. The child had a history of congenital malformation of the gastric outlet. The boy was given prokinetic agents considering the working diagnosis of functional dyspepsia, which alleviated his vomiting.

Although his vomiting had stopped, he was not asymptomatic. The boy was noticed to have continuous abdominal distension leading to a giant stomach along with worsening of his mental status.

On a plain radiograph of the abdomen, a lot of gas was seen (Figure 1). A computed tomography scan was done, which revealed a significantly distended stomach and 10 high-intensity shadows. CT scan also revealed a round focus of 1 cm in diameter, which was found obstructing the gastric outlet  (Figure 2).

An intrathoracic gastric volvulus was identified on the upper gastrointestinal imaging along with a wandering spleen, which together impaired the transit of the intraluminal contents if the cardia.

On account of the imaging results, the patient was diagnosed with gastric outlet obstruction.

Gastrointestinal decompression was performed. Approximately 2000 ml of slightly red-colored gastric content was drained. The patient was also provided with supportive care. Ultimately, the boy excreted the Myrica Rubra kernels.

His symptoms had begun after eating the Chinese bayberry, also called Chinese strawberry or Myrica Rubra. Ingestion of Myrcia Rubra, coupled with the congenital malformation, made the condition even worse. The obstructed stomach due to congenital malformation provided a harbor to the yeast to reproduce and ferment the food.

Image SOurce: Myrica Rubra

Patients with gastric obstruction may present with nausea, postprandial and non-bilious vomiting, early satiety, abdominal pain, and weight loss in chronic cases. The obstruction may be mechanical or due to motility disorders. In the latter, a majority of the cases remain unrecognized; the recognized medical conditions include diabetes mellitus, viral infections, and certain medications, including anticholinergics and opioids. The mechanical causes include:

  • Peptic ulcer disease
  • Use of non-steroidal anti-inflammatory drugs.
  • Polyps
  • Gastric volvulus
  • Gastric tuberculosis
  • Strictures
  • Helicobacter pylori (H. pylori)
  • Gastric carcinoma
  • Gastric lymphoma

There are high chances of misdiagnosis of gastric obstruction in patients with congenital malformation; therefore, it has a poor clinical outcome. It is imperative to diagnose promptly and accurately, and manage earlier in the course to improve the poor clinical outcome.

References:

Kumar A, Annamaraju P. Gastric Outlet Obstruction. [Updated 2020 Jun 22]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK557826/

Yu Y, Shi Y, Li Q, Zhang Y (2018) A Case of Gastric Obstruction: A Giant Stomach. Clin Med Img Lib 4:121. doi.org/10.23937/2474-3682/1510121

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Dr. Arsia Hanif has been a meritorious Healthcare professional with a proven track record throughout her academic life securing first position in her MCAT examination and then, in 2017, she successfully completed her Bachelors of Medicine and Surgery from Dow University of Health Sciences. She has had the opportunity to apply her theoretical knowledge to the real-life scenarios, as a House Officer (HO) serving at Civil Hospital. Whilst working at the Civil Hospital, she discovered that nothing satisfies her more than helping other humans in need and since then has made a commitment to implement her expertise in the field of medicine to cure the sick and regain the state of health and well-being. Being a Doctor is exactly what you’d think it’s like. She is the colleague at work that everyone wants to know but nobody wants to be. If you want to get something done, you approach her – everyone knows that! She is currently studying with Medical Council of Canada and aspires to be a leading Neurologist someday. Alongside, she has taken up medical writing to exercise her skills of delivering comprehensible version of the otherwise difficult medical literature. Her breaks comprise either of swimming, volunteering services at a Medical Camp or spending time with family.

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