Acute Gastric Volvulus: an Uncommon and Life-Threatening Disease

Excerpt

An 87-year-old man presented with a 3-day history of epigastric pain associated with anorexia, nausea, and vomiting. He had presented with unexplored mild dysphagia for several months, along with a maintained general condition. He had a medical history of asthma and atrial fibrillation, treated by acetylsalicylic acid and amiodarone. In the emergency room, he had no fever, and clinical examination revealed an abdominal distension with mild epigastric tenderness. Blood tests (i.e., complete blood count, serum electrolytes, C-reactive protein) were normal. The abdominal computed tomography (CT) showed a mesenteroaxial volvulus of the stomach (Fig. 1), revealed by a dilated stomach associated with a hernia of the pyloric antrum through the esophagus hiatus, mimicking a hiatal hernia. An oblique sagittal reconstruction showed a double beak sign, which corresponded to a crossing of the pyloric antrum and of the body of the stomach. There were no signs of gastric ischemia and no pneumoperitoneum. The gastric volvulus was surgically treated in emergency by laparoscopy, including the following steps: (i) exploration of the abdominal cavity in order to confirm the diagnosis and exclude both ischemia and gastric perforation (Fig. 2); (ii) cautious reduction of the volvulus; and (iii) esophageal hiatus closure and gastropexy. Postoperative course was uneventful with solid diet at day 1 and discharge at day 4.

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