What is Stale Food Vomitus
Stale food vomitus refers to vomited material containing undigested or partially digested food that has been retained in the stomach for an abnormally prolonged period, typically indicating delayed gastric emptying or gastric outlet obstruction.
Clinical Significance
Stale food vomitus is a key clinical finding that suggests:
- Gastroparesis or gastric outlet obstruction - When food remains in the stomach for hours to days beyond normal gastric emptying time, it becomes "stale" and may be vomited 1, 2
- Delayed gastric emptying - Normal gastric emptying occurs within 2-4 hours; stale food vomitus indicates retention well beyond this timeframe 1
Physical Examination Finding
- Succussion splash - The presence of a succussion splash on physical examination (a splashing sound heard when shaking the patient's abdomen) is suggestive of delayed gastric emptying or gastric outlet obstruction and correlates with the finding of stale food vomitus 1
Differential Diagnosis Context
In Adults with Gastroparesis
The diagnosis of gastroparesis is based on appropriate symptoms including nausea and vomiting (which may include stale food), delayed gastric emptying on testing, and absence of mechanical obstruction 1. Clinical symptoms suggesting gastroparesis include:
In Pediatric Populations
When evaluating vomiting in children, the characteristics of vomitus are critical 3:
- Bilious vomiting (green/yellow) indicates obstruction distal to the ampulla of Vater and is a surgical emergency 4, 5, 6
- Blood-stained vomitus requires urgent evaluation 3
- Stale food vomitus suggests gastric retention or motility disorder 1
Diagnostic Approach
When stale food vomitus is present, evaluation should include:
- Gastric emptying scintigraphy - The best accepted method to test for delayed gastric emptying, performed for 2-4 hours after ingestion of a radiolabeled solid meal 1
- Upper endoscopy - To exclude mechanical obstruction or mucosal lesions 7
- Antroduodenal manometry - Provides information about coordination of gastric and duodenal motor function in refractory cases 1
Important Clinical Pearls
- Distinguish from other vomiting patterns: Vomiting needs to be differentiated from regurgitation, rumination, and bulimia based on careful history 1
- Timing matters: The duration, frequency, and severity of symptoms together with characteristics of vomitus help narrow the differential diagnosis 1, 8
- Red flags: Bilious vomiting, blood-stained vomitus, signs of obstruction, or systemic symptoms require urgent evaluation 3