Abisola G. Baruwa Etti, MBBS
University of Connecticut Health Center, Farmington, CT
Introduction: Gastric volvulus is a rare clinical entity that involves rotation of the stomach along its long axis (organoaxial) or short axis (mesenteroaxial) through a perpendicular line connecting the greater and lesser curvatures. The most commonly observed association in adults is with a paraesophageal hernia.
Case Description/Methods: 60 year old female with a known paraesophageal hernia that was expectantly managed. She presented to the ED with a 10 hour history of intractable vomiting, dry heaves, epigastric discomfort and pleuritic chest pain. She denied constipation, fevers or chills. Vital signs were notable for tachycardia, tachypnea, hypoxia requiring 2L of supplemental oxygen via nasal cannula. She was in obvious painful distress. Lung auscultation revealed decreased breath sounds throughout all lung fields. Her abdomen was not distended but was tender in the right upper quadrant region without guarding or rebound tenderness. Initial work up included cardiac evaluation for acute coronary syndromes which was negative. Liver enzyme and lipase levels did not support a diagnosis of hepatitis or pancreatitis as the etiology of her presentation. Chest X-ray demonstrated a massive hiatal hernia. CT Angiogram of her chest revealed a very large hernia occupying much of the mid thorax, which was significantly increased compared to the prior study. Her hospital course was complicated by persistent epigastric discomfort, nausea, and inability to tolerate oral intake. Upper GI series was obtained to further evaluate the paraesophageal hernia, and it demonstrated findings consistent with an organoaxial gastric volvulus with evidence of gastric outlet obstruction. She underwent laparoscopic paraesophageal hernia repair, gastropexy with gastrostomy tube insertion. Post operatively, she was able to tolerate a regular diet and discharged successfully.
Discussion: An acute gastric volvulus is a potentially life-threatening condition that requires a high index of clinical suspicion. Its intermittent nature, vague symptoms, and rarity of the disease may make diagnosis difficult. Gastric volvulus is seldom considered when a patient presents with abdominal or chest pain, associated with nausea and vomiting. A prompt and correct diagnosis followed by immediate surgery remains a key factor in reducing the associated morbidity and mortality. Keeping this diagnosis in mind may help to avoid the many potential adverse outcomes associated with this uncommon disease.
Citation: Abisola G. Baruwa Etti, MBBS. P2690 - ACUTE GASTRIC VOLVULUS - A RARE COMPLICATION OF A PARAESOPHAGEAL HERNIA. Program No. P2690. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.