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Bhusal A, Bhattarai HB, Yogi TN, KC S, Katwal S, Bam PK. Acute gastric volvulus in adults: A rare case report and a comprehensive review. Radiol Case Rep 2024; 19:5916-5921. [PMID: 39328944 PMCID: PMC11424900 DOI: 10.1016/j.radcr.2024.08.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 08/20/2024] [Accepted: 08/21/2024] [Indexed: 09/28/2024] Open
Abstract
Acute gastric volvulus, a rare and life-threatening condition, often presents diagnostic challenges due to atypical symptoms. We report a unique case of nonincarcerated organo-axial gastric volvulus within a para-esophageal hiatus hernia in a 38-year-old male. Diagnosis relied on imaging, emphasizing the crucial role of CT scans. Successful open surgical intervention addressed the complexity, highlighting the evolving understanding and tailored approaches in managing this uncommon condition, essential for improved outcomes and reduced morbidity and mortality.
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Affiliation(s)
- Amrit Bhusal
- Department of Radio-diagnostics and Imaging; BP Koirala Institute of Health Sciences (BPKIHS), Dharan, Sunsari, Nepal
| | | | - Tek Nath Yogi
- BP Koirala Institute of Health Sciences (BPKIHS), Dharan, Sunsari, Nepal
| | - Suraj KC
- Department of General Surgery; BP Koirala Institute of Health Sciences (BPKIHS), Dharan, Sunsari, Nepal
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2
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Akiki L, Kawtharani AA, Abou Rached A, Semaan A, Geagea AS, Abi Abboud A. Endoscopic Management of Gastric Volvulus in an Elderly Patient With Multiple Comorbidities: A Case Report. Cureus 2024; 16:e63799. [PMID: 39099898 PMCID: PMC11297517 DOI: 10.7759/cureus.63799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2024] [Indexed: 08/06/2024] Open
Abstract
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.
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Affiliation(s)
- Laura Akiki
- Gastroenterology and Hepatology, Faculty of Medicine, Lebanese University, Beirut, LBN
| | | | - Antoine Abou Rached
- Internal Medicine - Gastroenetrology, Faculty of Medicine, Lebanese University, Beirut, LBN
| | - Antoine Semaan
- Anesthesia, Faculty of Medicine, Lebanese University, Beirut, LBN
| | - Antoine S Geagea
- Gastroenterology and Hepatology, Lebanese Hospital Geitaoui University Medical Center, Beirut, LBN
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3
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Littlewood M, O'Donnell C, Parsons S, Archer MS, de Boer HH. Fatal gastric volvulus: forensic pathology considerations and postmortem CT findings. Forensic Sci Med Pathol 2024; 20:534-541. [PMID: 37178446 PMCID: PMC11297049 DOI: 10.1007/s12024-023-00642-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2023] [Indexed: 05/15/2023]
Abstract
Gastric volvulus is a rare cause of gastric obstruction, due to the rotation of the stomach by more than 180°. It is a rare but life-threatening medical emergency that is considered difficult to diagnose at the initial clinical presentation. Forensic pathologists may be presented with gastric volvulus in several ways, for instance, as a cause of sudden and unexpected death or in the context of suspected clinical errors. The post-mortem examination of gastric volvulus may be challenging, due to the specific technical issues it presents and the various mechanisms by which volvulus may cause death. We therefore present five cases of gastric volvulus that in combination represent almost the entire spectrum of presentations and post-mortem findings, to discuss how gastric volvulus may come to the attention of a forensic pathologist, the approach and findings at post-mortem examination (including post-mortem CT), and the variety of mechanisms by which gastric volvulus may result in death.
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Affiliation(s)
- Marcus Littlewood
- University of Queensland Medical School, University of Queensland, 11 Wyndham St, Herston, QLD, 4006, Australia
| | - Chris O'Donnell
- Victorian Institute of Forensic Medicine/Department of Forensic Medicine, Monash University, 65 Kavanagh St, Southbank, Victoria, 3006, Australia
| | - Sarah Parsons
- Victorian Institute of Forensic Medicine/Department of Forensic Medicine, Monash University, 65 Kavanagh St, Southbank, Victoria, 3006, Australia
| | - Melanie S Archer
- Victorian Institute of Forensic Medicine/Department of Forensic Medicine, Monash University, 65 Kavanagh St, Southbank, Victoria, 3006, Australia
| | - Hans H de Boer
- Victorian Institute of Forensic Medicine/Department of Forensic Medicine, Monash University, 65 Kavanagh St, Southbank, Victoria, 3006, Australia.
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4
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McNellage L, Pacheco ZS, Shufflebarger EF. Massive Hiatal Hernia With Acute Gastric Volvulus Masked as a Suspected Food Poisoning: A Case Report. Cureus 2023; 15:e44943. [PMID: 37818520 PMCID: PMC10561523 DOI: 10.7759/cureus.44943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2023] [Indexed: 10/12/2023] Open
Abstract
We describe the case of a 69-year-old female who thought she had "food poisoning", which prompted her visit to the Emergency Department for evaluation of her vomiting and abdominal discomfort. Contrasted computed tomography imaging with contrast of the abdomen subsequently revealed the diagnosis of gastric volvulus, and the patient was promptly taken for surgical intervention. Gastric volvulus is rare and presents with a nonspecific history, exam, and laboratory findings. In the acute care setting, it is important to maintain a high clinical suspicion for this diagnosis, as timely imaging and intervention are crucial to decreasing patient morbidity and mortality.
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Affiliation(s)
- Landon McNellage
- College of Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, USA
| | - Zachary S Pacheco
- Emergency Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, USA
| | - Erin F Shufflebarger
- Emergency Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, USA
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5
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Uttinger K, Plum P, Gockel I. [57/m-Abdominal pain for several days with known alcohol abuse : Preparation for the medical specialist examination: part 28]. CHIRURGIE (HEIDELBERG, GERMANY) 2023; 94:3-7. [PMID: 37171594 DOI: 10.1007/s00104-023-01857-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/08/2023] [Indexed: 05/13/2023]
Affiliation(s)
- Konstantin Uttinger
- Klinik und Poliklinik für Viszeral‑, Transplantations‑, Thorax- und Gefäßchirurgie, Universitätsklinikum Leipzig, AöR, Liebigstr. 20, Building 4, 04103, Leipzig, Deutschland.
| | - Patrick Plum
- Klinik und Poliklinik für Viszeral‑, Transplantations‑, Thorax- und Gefäßchirurgie, Universitätsklinikum Leipzig, AöR, Liebigstr. 20, Building 4, 04103, Leipzig, Deutschland
| | - Ines Gockel
- Klinik und Poliklinik für Viszeral‑, Transplantations‑, Thorax- und Gefäßchirurgie, Universitätsklinikum Leipzig, AöR, Liebigstr. 20, Building 4, 04103, Leipzig, Deutschland
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6
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Sanekommu H, Siddiqui Z, Farrell A, Taj S, Saleh AB, Alsaadi E, Shah P. Gastric Outlet Obstruction Caused by Acute Gastric Volvulus: A Rare Complication of Hiatal Hernia. Cureus 2023; 15:e38609. [PMID: 37284380 PMCID: PMC10239683 DOI: 10.7759/cureus.38609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2023] [Indexed: 06/08/2023] Open
Abstract
Hiatal hernias are commonly encountered in elderly patients, predisposing patients to the common condition of gastroesophageal reflux disease (GERD). Depending on the size of the hernia, different complications can arise. Large hernias can lead to development of gastric volvulus, obstruction, strangulation, and perforation. Therefore, management of large hiatal hernias is crucial to avoid such complications. In this paper, we describe a patient who presented with acute gastric volvulus secondary to a large hiatal hernia. She improved with conservative management and subsequently underwent successful repair of the hernia. We emphasized the importance of identifying gastric volvulus among its vague presentation for prompt management.
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Affiliation(s)
| | - Zaid Siddiqui
- Internal Medicine, St. George's University School of Medicine, Saint George's, GRD
| | - Aidan Farrell
- Internal Medicine, Hackensack Meridian School of Medicine, Nutley, USA
| | - Sobaan Taj
- Internal Medicine, Jersey Shore University Medical Center, Neptune City, USA
| | - Arif B Saleh
- Internal Medicine, Jersey Shore University Medical Center, Neptune City, USA
| | - Ennis Alsaadi
- Internal Medicine, Jersey Shore University Medical Center, Neptune City, USA
| | - Pranav Shah
- Radiology, Jersey Shore University Medical Center, Neptune City, USA
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Hughes M, Huang D, Elbadri S, Falgiani M, Ganti L. Acute Gastric Volvulus in the Setting of a Paraesophageal Hernia With Hemoperitoneum: Emergency Department Diagnosis and Management. Cureus 2021; 13:e20404. [PMID: 35047248 PMCID: PMC8756554 DOI: 10.7759/cureus.20404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2021] [Indexed: 11/09/2022] Open
Abstract
Acute gastric volvulus is an uncommon emergency department (ED) presentation associated with high mortality from gastric ischemia and perforation. The diagnosis of this pathology is complicated by its intermittent symptoms and similarity in presentation to more common disorders encountered in the ED. Assessing for key risk factors, such as the presence of a hiatal hernia, and the use of expeditious imaging modalities, such as bedside radiography and point-of-care ultrasonography, are essential in rapid diagnosis and time-sensitive, definitive surgical intervention.
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Rodrigues C, Taveira I, Deus A, Rita H. Gastric Volvulus: A Multidisciplinary Approach and Conservative Treatment. Cureus 2021; 13:e13285. [PMID: 33728218 PMCID: PMC7955781 DOI: 10.7759/cureus.13285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Gastric volvulus can be defined as an abnormal rotation of the stomach. It can be both an emergency and a chronic intermittent problem. Being such a rare clinical entity and a difficult condition to diagnose, it is commonly diagnosed at the time of surgery or even at autopsy. We present the case of an 82-year-old independent female with a past medical history of hiatal hernia, who came to the emergency department with hematemesis and severe epigastric pain. An abdominal CT scan revealed an organoaxial stomach volvulus within the intrathoracic cavity. After initial treatment with gastric decompression, IV fluids and proton pump inhibitors, the patient was informed that the surgical intervention would be the only definitive curative treatment for her condition and denied the procedure. She was then discharged after clinical and analytical improvement. She was offered a conservative treatment and follow up by the internal medicine team. After a few months, the patient reported moderate improvement of her symptoms and less episodes of epigastric pain. She was pleased with the conservative management and denied any surgical or invasive procedures. A proximity contact was established with the family doctor, which she maintains. This case report is proof that rare entities can happen to patients presenting common symptoms and better resolutions come from multidisciplinary approaches.
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Affiliation(s)
- Carina Rodrigues
- Unidade de Cuidados Personalizados de Sines Family Medicine, Hospital Do Litoral Alentejano, Santiago do Cacém, PRT
| | - Isabel Taveira
- Internal Medicine, Hospital Do Litoral Alentejano, Santiago do Cacém, PRT
| | - Ana Deus
- General Surgery, Hospital Do Litoral Alentejano, Santiago do Cacém, PRT
| | - Henrique Rita
- Internal Medicine, Hospital Do Litoral Alentejano, Santiago do Cacém, PRT
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Abstract
Gastroduodenal perforation may be spontaneous or traumatic and the majority of spontaneous perforation is due to peptic ulcer disease. Improved medical management of peptic ulceration has reduced the incidence of perforation, but still remains a common cause of peritonitis. The classic sub-diaphragmatic air on chest x-ray may be absent and computed tomography scan is a more sensitive investigation in the stable patient. The management of perforated peptic ulcer disease is still a subject of debate. The majority of perforated peptic ulcers are caused by Helicobacter pylori, so definitive surgery is not usually required. Perforated peptic ulcer is an indication for operation in nearly all cases except when the patient is asymptomatic or unfit for surgery. However, non-operative management has a significant incidence of intra-abdominal abscesses and sepsis. Primary closure is achievable in traumatic perforation, but the management follows the Advanced Trauma Life Support (ATLS) principles.
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Affiliation(s)
- Elroy Patrick Weledji
- Department of Surgery, Faculty of Health Sciences, University of Buea, Buea, Cameroon
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Lourenço S, Pereira AM, Guimarães M, Nora M. Gastric Volvulus: A Complication of Hiatal Hernia. Cureus 2020; 12:e11123. [PMID: 33240716 PMCID: PMC7682922 DOI: 10.7759/cureus.11123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Gastric volvulus is a rare but potentially life-threatening condition, with difficult diagnosis. We present a case report of a demented woman aged 65 years that attended the emergency department with epigastric pain and vomiting for the past 10 days. The chest plain revealed a retrocardiac air-filled mass and the abdomino-pelvic computed tomography confirmed the diagnosis of gastric volvulus. The patient was admitted. A nasogastric tube was introduced, antibiotics and parenteric nutrition were started and the patient didn't eat anything. The patient was operated at fifth day of admission by laparoscopy. There weren't signs of gastric necrosis, so the stomach was mobilized for its natural position on abdominal cavity, the hiatal defect was closed and a Nissen fundoplicature was performed. The post operative period was uneventful and the patient was discharged on the third post-operative day, without any complication. This case illustrates a sub acute presentation form of gastric volvulus and a differed minimally invasive approach attending at the patient's clinical stability.
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Affiliation(s)
- Sara Lourenço
- General Surgery, Centro Hospitalar de Entre Douro e Vouga, Santa Maria da Feira, PRT
| | - Ana Marta Pereira
- General Surgery, Centro Hospitalar de Entre Douro e Vouga, Santa Maria da Feira, PRT
| | - Marta Guimarães
- General Surgery, Centro Hospitalar de Entre Douro e Vouga, Santa Maria da Feira, PRT
| | - Mário Nora
- General Surgery, Centro Hospitalar de Entre Douro e Vouga, Santa Maria da Feira, PRT
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Osorio JH, Trujillo JH, Gutiérrez JD, Cardona LF, Carvallo LM. Vólvulo gástrico, abordaje por laparotomía y laparoscopia. Revisión de la literatura a raíz de dos casos. REVISTA COLOMBIANA DE CIRUGÍA 2019. [DOI: 10.30944/20117582.99] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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