A rare etiology of acute abdominal syndrome in adults: Gastric volvulus - Cases series (original) (raw)
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Gastric Volvulus: A Rare Diagnosis of Abdominal Pain
Eurasian Journal of Emergency Medicine
Gastric volvulus (GV) is a rare but life-threatening condition in case of delay in diagnosis and treatment. Herein, we presented a case of GV due to Morgagni hernia presenting to the emergency department with complaints of abdominal pain and distention. A 59-year-old male patient was admitted to the emergency department with abdominal pain and distension, nausea and vomiting. His past medical history included coronary artery disease, hypertension, multiple sclerosis and left diaphragmatic hernia. On initial examination, pulse rate was 119/min and other vital signs were normal. Abdominal examination revealed epigastric tenderness. Posteroanterior chest X-ray showed an air bubble in the left hemithorax. Thoracoabdominal CT was performed for differential diagnosis. Department of Emergency Radiology reported a mesenteroaxial gastric volvulus at the superior gastro-esophageal junction with a Morgagni hernia including left hemidiaphragmatic defect with herniation of the gastric corpus, first part of the duodenum and transverse colon. Following placement of the nasogastric tube, 1300 mL gastric secretion was drained and abdominal distention was relieved. Patient was referred to the operating room. Morgagni hernia and the diaphragm defect were repaired. During follow-up in general surgery ward, a sudden cardiac arrest developed on the 5 th day and he died. If a patient presents to the emergency departmen with abdominal pain and distention, GV should be considered in the differential diagnosis, although rare.
Internal and Emergency Medicine
An 18-year-old man presented with complaints of sudden onset pain in the epigastrium radiating to the left lower chest, starting 7 days prior followed by non-productive and persistent retching. On examination, the patient had a tachycardia (pulse rate 108 beats/min) and a blood pressure of 102/66 mmHg. His respiratory rate was 22 breaths/min and was afebrile. On chest examination, air entry was markedly reduced on the left side. The abdomen was not distended; an ovoid-shaped tender organ was felt in the epigastrium. The rest of the abdominal examination was normal. A single gentle attempt of nasogastric tube insertion was done, but insertion beyond the first mark was not possible. A plain X-ray study of the chest and abdomen done earlier showed a double bubble sign ( , Contrast films showed a dilatated and tortous dumbbell-shaped stomach overlapping the left lower chest . Although a computed tomography (CT) scan of the abdomen would have been preferable, the barium study had been done before the patient was referred to us .
Acute gastric volvulus through an unsuspected diaphragmatic hernia
Journal of Pediatric Surgery Case Reports, 2018
Acute gastric volvulus occurs when the stomach undergoes torsion in the thoracic cavity. It may result from an accompanying enlargement of the hiatus or a missed congenital diaphragmatic hernia (CDH). We describe a 12year-old girl who presented to our emergency department with acute epigastric pain and non-bilious vomiting. An incidental finding of diaphragmatic hernia with hugely dilated stomach was diagnosed by plain X ray, Ultrasound (US) and Computed tomography (CT) abdomen with oral contrast. She underwent laparotomy and gastric volvulus was found. Reduction of the viscera to the abdominal cavity and repair of diaphragmatic defect was done. She recovered with accepted general condition and was discharged five days later.
Acute Gastric Volvulus: Diagnosis and Management over 10 Years
Digestive Surgery, 2006
Background/Aims: Gastric volvulus is a rare, potentially lifethreatening condition, which is difficult to diagnose. This study represents a series of patients with acute gastric volvulus. Methods: All patients presenting with acute gastric volvulus over a 10-year period were reviewed. Results: Twenty-one patients with a median age of 66 years were identified. Acute gastric volvulus was secondary to a paraesophageal hiatus hernia in 16 patients. The major symptoms were abdominal pain, vomiting and upper gastrointestinal bleeding/anemia. The most useful investigations were barium studies and upper gastrointestinal endoscopy. Treatment was open surgery in all patients. There were no major complications and no deaths. Median hospitalization was 8 days. Conclusion: Acute gastric volvulus is a rare condition which requires a high index of suspicion for diagnosis, which is usually based on imaging studies. The treatment is immediate surgery. Volvulus can be treated successfully by open surgery with minimal morbidity and short hospitalization.
Eventration of Diaphragm Complicated by Gastric Volvulus in Elderly Female: A Case Report
Journal of Evolution of medical and Dental Sciences, 2014
We report a 64 year old female who presented with epigastric pain and intractable vomiting not respond to treatment and we were not able to pass nasogastric tube. Chest x-ray shows eventration of left sided hemi diaphragm, upper gastro intestinal contrast study conform the diagnosis of gastric volvulus. Plication of left hemidiaphragm with anterior gastropexy was performed through an abdominal approach. Postoperatively the patient's symptoms improved. Acute gastric volvulus carries a mortality rate of 42-56%, secondary to gastric ischemia, perforation or necrosis. 1 Emergency physicians should have suspicion about gastric volvulus when treating patients with abdominal pain and persistent vomiting. The patient should go for surgical consultation as early as possible.
Gastric volvulus due to diaphragmatic eventration and paraesophageal hernia
journals.tubitak.gov.tr
Abstract: Acute gastric volvulus occurs when the stomach or a part of it rotates more than 180 degrees. It is a potentially life-threatening entity and most cases of gastric volvulus occur in association with eventration of left hemidiaphragm or a hiatal hernia. Gastric volvulus is a rare ...
Gastric Volvulus: A Complication of Hiatal Hernia
Cureus
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.
Gastric Volvulus: A Multidisciplinary Approach and Conservative Treatment
Cureus, 2021
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.
Gastric volvulus and attendant complications
Annals of African Surgery, 2019
The diagnosis of a hiatal hernia, a gastric volvulus or its attendant complications, can be easily missed because evaluation of acute abdominal pain can be difficult, particularly in resource-limited settings. Diagnosis of a gastric volvulus is even harder in the pediatric population because its peak occurrence is in the fifth decade. Hiatal hernia (and gastric volvulus) can be found incidentally in chest radiographs that are requested routinely or in suspected pulmonary pathology. The gold standard diagnostic tool for a gastric volvulus is a barium swallow. The optimal treatment method is open laparotomy with detorsion, and prevention of recurrence with anterior gastropexy. We present a case of an 8-year-old girl who had a diagnosis of hiatal/paraesophageal hernia with a gastric volvulus complicated by ischemia, necrosis, perforation and collapse of the left lung. A complete history and a thorough evaluation of the sick-looking patient are paramount in diagnosing life-threatening conditions like gastric volvulus.
Laparoscopic repair of gastric volvulus with diaphragmatic hernia: a case report
International Surgery Journal, 2015
Patient was admitted and posted for laparoscopic surgical intervention. There was gastric volvulus with diaphragmatic hernia (Figure 2). Complete stomach was reduced from diaphragmatic rent. Hiatus was normal with Para hiatal diaphragmatic rent. Rent was repaired by ABSTRACT Gastric volvulus is a rare but potentially life-threatening cause of upper gastrointestinal obstruction. Emergency surgeon must maintain a high index of suspicion in patients who present with signs and symptoms suggesting foregut occlusion. We report an illustrative case and review the pathogenesis, classification, diagnosis and laparoscopic treatment of this rare entity.