Gastric Volvulus: A Rare Entity Case Report and Literature Review

Gastric volvulus and splenopancreatic torsion with wandering spleen: A case report

INTRODUCTION AND IMPORTANCE

Gastric volvulus is an uncommon potentially life-threatening medical condition characterized by rotation of the stomach or part of the stomach around its longitudinal or transverse axis. Acute gastric volvulus usually presents with the triads of epigastric pain, nonproductive retching, and inability to pass the nasogastric tube. Diagnosis is assisted with abdominal and chest x-ray and contrast studies.

CASE PRESENTATION

A 53-year-old female presented with abdominal pain of two days duration which started at the epigastric region and later on became diffuse all over the abdomen. She had associated frequent episodes of vomiting which were initially bilious followed by nonproductive retching and low-grade intermittent fever. Abdominal examination showed a distended, diffusely tender abdomen with an ill-defined epigastric mass. Abdominal X-ray showed central abdominal circular opacity continuous with stomach outline. Intraoperative findings revealed perforated gangrenous mesenteroaxial gastric volvulus and splenopancreatic torsion with wandering spleen. Proximal subtotal gastrectomy with esophagogastric anastomosis and splenopexy was performed. The patient was discharged on the 10th postoperative day and had an uneventful post-operative recovery.

CLINICAL DISCUSSION

Primary gastric volvulus is usually mesenteroaxial with the pylorus commonly rotating anteriorly. Primary gastric volvulus can be associated with congenital asplenia and wandering spleen as both conditions are characterized by absent or loose ligamentous attachments. This case was a mesenteroaxial volvulus with splenopancreatic torsion with a wandering spleen caused by abnormal ligamentous attachments.

CONCLUSION

A high index of suspicion for early diagnosis of gastric volvulus and timely intervention is required to improve treatment outcome.

Mesentero-axial gastric volvulus treated with laparoscopic gastropexy: a case report

BACKGROUND

Mesentero-axial gastric volvulus (MAGV) is an uncommon subtype of gastric volvulus (GV). However, reports of such cases in adult patients are very rare. We present an unusual case of idiopathic MAGV in an old woman.

CASE PRESENTATION

An 84-year-old woman was referred to the emergency department for vomiting and abdominal pain. An abdominal computed tomography scan revealed a mesentero-axial gastric volvulus, which could be corrected endoscopically, and the symptoms were relieved. Contrast-enhanced examination was performed before the elective surgery to confirm the presence of short-axis dorsal 180-degree volvulus. The patient underwent laparoscopic surgery on a wait-and-watch basis. After releasing the torsion, the stomach returned to normal position. The gastric fornix was sutured to the left diaphragm and the gastric body and antrum were sutured to the abdominal wall using non-absorbable thread. Symptoms did not flare after the surgery.

CONCLUSIONS

We experienced a rare case of adult MAGV presenting with incomplete obstruction. Laparoscopic gastropexy is useful when gastric decompression is achieved.

Acute Mesenteroaxial Volvulus in the Setting of Chronic Paraesophageal Hernia: A Case Report

Hiatal hernia is a common finding in radiologic and gastroenterology evaluations. Here, we present a patient with an uncommon paraesophageal subtype who was managing her hiatal hernia symptoms conservatively and eventually developed the rare complication of mesenteroaxial gastric volvulus. The chronic history of this patient's hiatal hernia with classic complaints suggestive of gastric ischemia prompted clinical suspicion of volvulus. Here, we discuss the initial clinical presentation of this patient, imaging study, and emergent surgical intervention by robot-assisted laparoscopic gastric volvulus reduction, hiatal hernia repair, and Nissen fundoplication. Although the size and axis of rotation of this patient's volvulus made this case challenging, the prompt intervention prevented complications associated with volvulus and ischemia.

Mesentero-axial gastric volvulus in an old woman: a case report of a diagnostic challenge

Gastric volvulus is a rare conditiom defined as an abnormal rotation of the stomach around itself. Acute gastric volvulus is a surgical emergency because it is a life-threatening condition, but its non-specific symptoms make diagnosis difficult. There are two types of gastric volvulus: organoaxial and mesentero-axial. The treatmet is surgical intervention. Computed tomography allows to identify and classify gastric volvulus and rule out complications so that to guide surgery management. We report a case of a mesentero-axial gastric volvulus in an old woman with abdominal pain, who underwent surgery in laparoscopy.

An Unusual Case of an Acute Mesenteroaxial Gastric Volvulus Secondary to a Hiatal Hernia

Gastric volvulus is characterized by the abnormal twisting of the stomach along its axis. It is a rare condition that can develop secondary to an underlying gastrointestinal anatomic defect such as a hiatal hernia. Gastric volvulus may present acutely with symptoms of gastric outlet obstruction and can lead to potentially fatal complications, if not treated in a timely manner. We present the case of a 74-year-old woman who presented with an acute mesenteroaxial gastric volvulus with gastric outlet obstruction that developed secondary to a large hiatal hernia.

Acute gastric volvulus following rapid and incomplete chewing of vegetables: A case report

One of the rare but serious causes of acute abdomen is gastric volvulus. It is considered an emergent surgical condition when it takes place acutely due to the risk of gastric strangulation, gangrene, and perforation. In this study, we introduce a case of a previously healthy young adult patient who presented with sudden severe epigastric and left upper quadrant abdominal pain along with nausea and retching following insufficient mastication and rapid swallowing of large amounts of vegetables. Radiological studies with chest and abdominal X-rays were in favor of acute gastric outlet obstruction and finally, laparotomy confirmed the diagnosis of acute, primary mesenteroaxial gastric volvulus. We postulated a probable justifying mechanism of the presence of a flaccid gastrocolic ligament (found through the laparotomy) besides rapid entrance of great pieces of vegetables into the stomach precipitated instant gastric rotation.

A comprehensive radiologic review of abdominal and pelvic torsions

The clinical manifestations of abdominal and pelvic organ torsion can often be non-specific and can affect a wide range of ages and demographic groups. Radiologists have a key role in not only establishing the diagnosis of organ torsion, but also in the assessment of potential complications. As multiple imaging modalities may be utilized in the evaluation of abdominal and pelvic pain, recognizing the various appearances of organ torsion is important to ensure early diagnosis and thereby reducing patient morbidity and mortality, particularly since abdominal and pelvic organ torsion may not be clinically suspected at the time of initial patient presentation.

Video-Laparoscopic Treatment of Intrathoracic Gastric Volvulus

Background

Gastric volvulus is a rare condition, characterized by abnormal rotation of the stomach, causing obstruction with risk of ischemia, necrosis, and perforation. It is associated with high morbidity and mortality rates and, as it is life threatening, early diagnosis and treatment are crucial.

Methods

Retrospective study of medical records of intrathoracic gastric volvulus patients treated by video-laparoscopy from January 2000 to December 2018, in a University Hospital.

Results

Thirty patients (34 surgical procedures - 4 re-operations), 9 (30%) male and 21 (70%) female. The mean age was 57.65 ± 32.65 and the mean body mass index was 27.11 ± 3.5 kg/m². The most prevalent symptoms were epigastric pain and dysphagia. In 41.17% of the cases, the contrast X-ray confirmed the diagnosis. All 34 cases were intrathoracic volvulus, 24 of which were organo-axial (70.58%). The surgical technique used was hiatoplasty, without mesh (25 cases; 73.52%) and with reinforcement mesh (9 cases; 26.47%), mostly associated with Nissen fundoplication (52.94%). The mean surgical time was 215.7 ± 62.9 minutes, with conversion in 5 cases (15.62%). Hospitalization ranged from 4 ± 2 days. There was no record of operative mortality, and symptom improvement occurred in 100% of patients. The mean follow-up time for patients was 41.8 ± 32.6 months.

Conclusions

Surgical treatment should be indicated to reduce morbidity and mortality, and associated with improved symptoms and patient prognosis. Video-laparoscopic surgery on intrathoracic gastric volvulus proved to be safe and effective and should be the option of choice in the management of this disease.

Adult primary gastric volvulus, a report of two cases

Gastric volvulus is the medical situation that a stomach is twisted beyond the physiological range. It is a rare disease which is hard to experience in routine medical examination. Principally surgical treatment is essential for the acute type. However, the conservative therapy should be attempted in some cases, such as decompression of a stomach with a nasogastric tube, endoscopic reduction and so forth. Concerning surgical operation, the base is reduction of the torsion and immobilization of stomach. Recently, laparoscopic surgery is performed for the case that the general condition is stable or chronically progressive in the early stages. Percutaneous endoscopic gastrostomy (PEG) had also been performed for gastric immobilization. However, the recurrences and problems of twisting around the gastrostomy site were reported in addition to the problem of cosmetic outcomes. Therefore, the case is decreasing. In this paper, we present two cases on adult primary gastric volvulus. For the first case, endoscopic reduction was not good enough to release the torsion state. Then laparoscopic gastropexy was performed successfully. For the second case, we succeeded in endoscopic reduction. Since the patient had already experienced gastric volvulus, laparoscopic surgery was performed. The upper and middle gastric bodies were secured to the anterior abdominal wall, and gastric antrum to the ligamentum teres hepatis with interrupted absorbable sutures respectively. However, partial gastric volvulus recurred after ten and a several days postoperatively due to cutting off of the suture at the antrum secured to the ligamentum teres hepatis at previous surgery. Then, PEG for 2 points of lower body and antrum were performed to secure the antrum. The gastrostomies were removed 6 months after the surgery. Immobilization by laparoscopic gastropexy and PEG are useful for gastric volvulus due to their significant merit of minimum invasiveness. Concerning gastropexy, the number of sutures is very important for the secured part not to be torn off.

Organoaxial gastric volvulus: a rare cause of an acute abdomen

We report the case of a 65-year-old male patient with massive epigastric pain of sudden onset and vomiting due to an organoaxial volvulus of the stomach. We comment on the surgical management in our case and discuss etiology and therapeutic options of this rare entity.