Gastric Volvulus Masquerading as Myopericarditis

Abstract

An 84 year-old woman with no known coronary artery disease presented to the hospital complaining of chest discomfort, dyspnea, and multiple episodes of non-bilious, non-bloody emesis, and diffuse abdominal pain that woke her up from her sleep. In the emergency room, the patient was found to have diffuse ST elevation with a troponin of 0.4 ng/mL, an amylase 614 U/L, and a lipase 986 U/L. Her chest X-ray showed a large air lucency below the left hemidiaphragm causing it to be elevated. A cardiac catheterization was performed which revealed non-obstructive coronary disease and normal left ventricular function. A diagnosis of myopericarditis was made. A CT scan of the abdomen and pelvis was subsequently performed which demonstrated a gastric volvulus, with the antrum lying above the fundus that compressing the heart. A surgical intervention was not performed given of the diagnosis of myopericarditis as well as the chest pain and dyspnea. A nasogastric tube was placed for decompression. Endoscopic gastropexy with the placement of two percutaneous endoscopic gastrostomy tubes was performed. An upper GI series revealed resolution of the volvulus. The patient's troponin trended downward and her EKG normalized. Since She was able to tolerate a regular diet with no further chest pain,or abdominal pain, or vomiting. She was discharged from the hospital. Gastric volvulus is a rare condition that is characterized by an abnormal rotation of the stomach. Rotation along the longitudinal axis is termed organoaxial volvulus while rotation around the transverse axis is termed mesenteroaxial volvulus. It is commonly caused by adhesions, diaphragmatic hernias, paraesophageal hiatal hernias, and can be post surgical, or idiopathic. The classic presentation of a patient with a gastric volvulus includes epigastric pain, nausea, vomiting and/or nonproductive retching. There are a few case reports describing a gastric volvulus mimicking cardiac chest pain with EKG changes, but this is the first case where a gastric volvulus presented with diffuse ST-elevations and an elevated positive troponin due to an adjacent dilated antrum irritates the heart.Figure 1Figure 2Figure 3