2687 A Rare Case of Organoaxial Volvulus of the Stomach

Abstract

INTRODUCTION: Gastric volvulus is an uncommon and potentially life-threatening clinical entity characterized by rotation of the stomach along its long or short axis provoking variable degrees of gastric outlet obstruction. Clinical presentation varies between acute and chronic volvulus. Here we present a rare case of chronic organoaxial volvulus presenting with dysphagia. CASE DESCRIPTION/METHODS: The patient is an 87 year old male with a medical history of hypertension, obstructive sleep apena, multi-nodular goiter (with thyroid resection resulting in vocal cord paralysis) who was referred to the gastroenterology clinic for dysphagia. The patient states he had dysphagia to solids for one year. The patient denied associated nausea, vomiting, hematemesis, hematochezia, constipation or unintended weight loss. Complete blood count and comprehensive metabolic panel at that time were unremarkable. Physical exam was also unremarkable. Given his symptoms a barium swallow was ordered to further evaluate his gastrointestinal tract. This was done and showed no evidence of esophageal obstruction or esophageal mass, but did incidentally find organoaxial rotation of the stomach. The patient was scheduled to undergo upper esophagogastroduodenoscopy, but was non-compliant with the appointment and lost to follow up. DISCUSSION: Acute gastric volvulus usually presents with sudden onset abdominal or chest pain, severe retching with occasional vomiting, and epigastric distention. Chronic gastric volvulus on the in contrast can present with a complete absence of symptoms to non- specific symptoms, such as abdominal pain, dyspepsia, dysphagia, acid reflux, nocturnal cough, hiccups, non-bilious vomiting, weight loss, and anemia. Diagnosis of gastric volvulus is conventionally achieved with chest radiograph, upper barium studies or CT- scan. Regardging treatment of acute symptomatic gastric volvulus, nasogastric decompression is usually the first step, followed by surgery. Some patients at high risk for surgery, mainly elderly, can also be treated endoscopically with adequate decompression and reduction of the stomach and placement of a gastrostomy tube to gastropexy the stomach to the abdominal wall.