Acute Organoaxial gastric volvulus: A massive problem with a twist-case report. (2017)

• Record Type: Journal Article
• Authors: Al Daoud, Fadi; Daswani., Gul Sachwani; Perinjelil, Vinu; Nigam, Tina
• Is Part Of: International journal of surgery case reports. Volume 41(2017)
• Page Start: 366
• Page End: 369
• Publication Date: 2017
• Subjects: GV gastric volvulus -- GJ gastrojejunal -- UGI upper gastrointestinal -- POD post-operative day; Gastric volvulus -- Organoaxial -- Mesenteroaxial -- Borchardt's triad -- Foregut obstruction -- Gastropexy; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; Surgery; Electronic journals; Periodicals; 617.005
• DOI: 10.1016/j.ijscr.2017.11.016
• Languages: English
• ISSNs: 2210-2612

Abstract

Highlights: Gastric volvulus may have a chronic component which can then progress to an acute surgical emergency. Acute on chronic gastric volvulus is extremely challenging to diagnose given the vague and atypical abdominal complaints. When gastric volvulus evolves to acute in nature, the appropriate workup for an acute abdomen should be performed. Prompt evaluation with surgical intervention is key in the management of acute gastric volvulus to avoid complications such as gastric necrosis. Abstract: Introduction: Gastric volvulus (GV) is a rare and life threatening condition if not treated promptly or wrongly diagnosed. The main complication of gastric volvulus is foregut obstruction. The extreme rotation can cut off blood supply to the stomach and even distal organs, which can lead to ischemia and necrosis of the affected area. Presentation of case: We report a case of a 41yo female that complained of severe abdominal pain, nausea and vomiting for approximately 3 days after eating a large meal. The patient didn't have any flatus or bowel movements in the last 24 h. CT of the abdomen and pelvis showed a dilatation of the stomach and esophageal hernia. Laparotomy confirmed an organoaxial volvulus at the level of the antrum and body of the stomach. Gastropexy was implemented and the stomach fixed to the posterior abdominal wall to prevent recurrence. Discussion: GV may have a significant related morbidity and mortality rate. It can be missed easily on diagnosis. The presence of vomiting not responding to initial antiemetic treatment, as well as, the presence of a hiatal hernia on the imaging studies should trigger our thinking of gastric volvulus, regardless of the stable appearance of the patient. Conclusion: Chronic GV can manifests as atypical chest, abdomen and gastro intestinal symptoms. We recommend that everyone with these atypical symptoms seek medical attention to rule out GV. Early diagnosis and treatment will reduce the risk of developing chronic gastric volvulus to acute gastric volvulus.