CASE 2192 Published on 11.10.2003

Aerophagia and hyperventilation

Section

Abdominal imaging

Case Type

Clinical Cases

Authors

De Temmerman G

Patient

22 years, female

Clinical History
Abdominal pain, belching, flatulence, abdominal distension, normal bowel sounds and no signs of peritoneal irritation.
Imaging Findings
The patient presente with abdominal pain, excessive belching and flatulence. She appeared anxious and was hyperventilating. Clinical examination revealed abdominal distension with normal frequency and intensity of bowel sounds. There were no signs of peritoneal irritation. Laboratory results showed no elevated inflammatory parameters.

A plain supine radiograph of the abdomen (Fig. 1) showed a remarkable gas-filled stomach. The entire small bowel and large bowel were uniformly filled with air. The bowel wall and folds seemed normal. No free air was seen. The patient was too dizzy to take an upright radiograph. A lateral decubitus view (not shown) revealed no air-fluid levels.
Discussion
Gas in the gut results from swallowed air, intraluminal production and diffusion from the blood. Aerophagia is characterised by excessive air swallowing, leading to abdominal distension and gas-related symptoms such as flatulence, bloating and belching. To our knowledge only little has been written in the radiological literature about aerophagia. It is believed to be a purely functional gastrointestinal disorder, although the pathophysiology remains poorly understood. Early recognition and diagnosis is very important to avoid unnecessary and expensive diagnostic tests. Questioning and clinical examination usually suffice to differentiate it from adynamic ileus, in which supine radiographs can look very similar. In adynamic ileus, intestinal motor activity is absent or severely decreased. Fluid and gases do not progress normally through the non-obstructed small and large bowel with consequent retention of large amounts of bowel contents. The standard plain abdominal films in adynamic ileus show pathological bowel distension (supine view) and air-fuid levels (upright or lateral decubitus views). A vast variety of pathological conditions can elicit adynamic ileus: surgical procedures, peritonitis, abdominal trauma, shock, sepsis, chest diseases, renal colics, etc. Patients with adynamic ileus are usually very ill and clinical examination is clearly abnormal.

Aerophagia usually resolves spontaneously with medical symptomatic therapy and psychotherapy. Rare complications are intestinal rupture, pneumoperitoneum, volvulus and bowel infarction.
Differential Diagnosis List
Aerophagia
Final Diagnosis
Aerophagia
Case information
URL: https://eurorad.org/case/2192
DOI: 10.1594/EURORAD/CASE.2192
ISSN: 1563-4086