2689 Gastric Volvulus: A Difficult Situation of Diagnosis and Management

Abstract

INTRODUCTION: Gastric volvulus is a rare entity defined as an abnormal rotation of the stomach around its short or long axis leading to variable degrees of gastric inlet and outlet obstruction. Organoaxial and mesentericoaxial volvulus are distinguished according to the direction of rotation. A rotation of more than 180 degrees can cause strangulation, necrosis and finally perforation. CASE DESCRIPTION/METHODS: We present the case of a 43-year-old female that complained of severe abdominal pain, nausea and vomiting for 2 days after eating a large meal. She did not have any flatus or bowel movements in the last 48 hours. On admission in our clinic, biological findings included an inflammatory syndrome, an anaemic syndrome and hypokalaemia. The radiology images highlighted a high air-fluid level in the chest and the ultrasound examination showed a significant stomach fluid distension. The upper digestive endoscopy revealed multiple ulcerated lesions and stasis fluid at the gastric angle, a point from which exploration could no longer be continued. Computed tomography (CT) of the abdomen and pelvis showed a dilatation of the stomach and the displacement of the antrum above the gastroesophageal junction; the stomach appeared upside-down with the antrum and pylorus superior to the fundus and proximal body. Based on clinical manifestations, biological results, radiograph images, ultrasounds, upper endoscopy and CT scan, the patient was diagnosed with high occlusion via congenital organo-axial volvulus. Initial management was nasogastric decompression to decrease the intragastric pressure. The patient was transferred to the Surgery Department, where he underwent a laparotomy which confirmed an organoaxial volvulus at the level of the antrum and body of the stomach. Gastropexy was implemented and the stomach fixed to the posterior abdominal wall to prevent recurrence. Postoperative recovery was uneventful and the patient returned to his rehabilitation facility on the fourth post-operative day. DISCUSSION: We present this case because it is an uncommon life-threatening disease. Given its rarity and unusual presentation, the clinical index of suspicion is always low. Diagnosis of gastric volvulus is challenging due to the non-specificity of the symptoms and rarity of the condition. Early diagnosis and treatment will reduce the risk of developing chronic gastric volvulus to acute gastric volvulus.