Abstract
IntroductionGastric volvulus is a rare condition. Presenting acutely, mesenteroaxial gastric volvulus has characteristic symptoms and may be easily detected with upper gastrointestinal contrast studies. In contrast, subacute, intermittent cases present with intermittent vague symptoms from episodic twisting and untwisting. Imaging in these cases is only useful if performed in the symptomatic interval.Case presentationWe describe a patient with a long history of intermittent chest and epigastric pain. An earlier barium meal was not diagnostic. Diagnosis was finally secured during the current admission by a combination of (1) serum investigations, (2) endoscopy, and finally (3) computed tomography.ConclusionNon-specific and misleading symptoms and signs may delay the diagnosis of intermittent, subacute volvulus. Imaging studies performed in the well interval may be non-diagnostic. Elevated creatine kinase and aldolase of a non-cardiac cause and endoscopic findings of ischaemic ulceration and difficulty in negotiating the pylorus may raise the suspicion of gastric volvulus. In this case, abdominal computed tomography with spatial reconstruction was crucial in securing the final diagnosis.
Highlights
Case presentation: We describe a patient with a long history of intermittent chest and epigastric pain
Elevated creatine kinase and aldolase of a non-cardiac cause and endoscopic findings of ischaemic ulceration and difficulty in negotiating the pylorus may raise the suspicion of gastric volvulus
Abdominal computed tomography with spatial reconstruction was crucial in securing the final diagnosis
Summary
Imaging, performed in the well interval, may be non-diagnostic. Endoscopic abnormalities such as ischaemic ulceration and difficulty in negotiating the pylorus, coupled with biochemical abnormalities such as elevated creatine kinase and aldolase of a non-cardiac cause, should raise the suspicion of gastric volvulus. It provides spatial reconstruction of the acquired images and allows choice of treatment based on additional findings suggestive of necrosis, dense adhesions and associated diaphragmatic or hiatal hernias. Written informed consent was obtained from the patient for publication of this case report and accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal
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