‘Back-and-Forth Stomach’ CT Imaging Findings of a Pathophysiologic Entity Causing Acute Gastric Volvulus

Endoscopic Management of Gastric Volvulus in an Elderly Patient With Multiple Comorbidities: A Case Report

Gastric volvulus is a rare condition whose incidence remains largely unknown. Unless actively considered by healthcare providers, the diagnosis of gastric volvulus, which can lead to significant morbidity and mortality, may be overlooked. This condition can manifest in either acute or chronic forms, presenting with diverse symptoms. Notably, the presence of a hiatal hernia alongside persistent vomiting despite initial antiemetic therapy should raise suspicion for gastric volvulus, even if the patient appears clinically stable. Acute gastric volvulus is usually managed surgically. Here, we describe the case of an elderly male who was diagnosed with acute gastric volvulus and was treated conservatively with endoscopy.

Redescending Stomach: A Rare and Potentially Lethal Complication of Gastric Herniation

Large gastric hernias are common and usually cause minor symptoms. Rarely, complete intrathoracic herniation of the stomach is complicated by strangulation. The underlying mechanism can be gastric volvulus or the less recognized phenomenon of gastric fundus redescent. We describe a case where this rare but potentially lethal complication of gastric herniation is present. Additionally, we show that gastric pneumatosis, a sign associated with ischemia, can be initially visualized on a plain chest radiograph in this setting. Teaching point: Redescent of the fundus is a possible, but unrecognized cause of gastric strangulation in intrathoracic stomachs.

Upside-down stomach in paraesophageal hernia: A case report

RATIONALE

Paraesophageal hernias, accounting for a mere 5% to 10% of all hiatal hernias, occasionally present an exceedingly uncommon yet gravely consequential complication characterized by the inversion of the stomach. Delving into the clinical manifestations and optimal therapeutic approaches for patients afflicted by this condition merits substantial exploration.

PATIENT CONCERNS

A 60-year-old man was referred to our hospital with acute onset of severe epigastric pain, abdominal distension, and vomiting. A chest radiograph unveiled an elevated left diaphragmatic dome accompanied by a pronounced rightward shift of the mediastinum. Subsequent abdominal computed tomography imaging delineated the migration of the stomach, spleen, and colon into the left hemithorax, facilitated by a significant diaphragmatic defect.

DIAGNOSES

The diagnosis of a giant paraesophageal hernia with complete gastric inversion was established through a comprehensive evaluation of the patient's clinical manifestations and imaging findings.

INTERVENTIONS

Surgical intervention was performed on the patient. During the procedure, a left diaphragmatic defect measuring approximately 10 × 8 cm was identified and meticulously repositioned, followed by the repair of the diaphragmatic hernia. The herniated contents comprised the pancreas, stomach, spleen, a segment of the colon, and a portion of the greater omentum.

OUTCOMES

The patient experienced a smooth postoperative recuperation and was discharged 12 days following the surgical procedure. Subsequently, during a 7-month follow-up period, the patient continued to exhibit favorable progress and recovery.

LESSONS

Paraesophageal hernias are rare, and the presence of an inverted stomach in a giant paraesophageal hernia is exceptionally uncommon. Clinical presentation lacks distinct features and can lead to misdiagnosis. This case emphasizes the importance of timely surgical intervention guided by imaging, offering valuable clinical insights.

Gastric obstruction secondary to abdominal re-herniation of a giant hiatal hernia. An illustrative case to understand the pathophysiology of gastric volvulus

Purpose: To depict the characteristics of a special type of gastric volvulus caused by acute re-herniation of a previous hiatal hernia.Materials and methods: We present the case of a male patient with known history of a giant hiatal hernia who presented to our emergency department with a chief complaint of epigastric pain, oral intolerance and incoercible vomiting in the last 24 h. On suspicion of abdominal complication, an emergent computed tomography (CT) scan was performed.Results: Gastric volvulus secondary to downward re-herniation of the fundus into the abdominal cavity was the cause of this patient's symptoms. This mechanism, which was demonstrated by comparing the CT findings of the acute episode with previous imaging studies, reveals a largely unrecognized pathogenic mechanism of gastric volvulus.Conclusions: Acute gastric volvulus should be suspected in patients with hiatal hernia. CT allows its diagnosis and likely underlying pathophysiological mechanism.