Gastric volvulus, plus duodenal diverticulum and calcified gall-bladder.
An 89-year old woman with a six-month history of post-prandial bloating and vomiting. She was unable to tolerate solid meals. Endoscopy showed a large paraesophageal hernia and the duodenum could only be entered with difficulty. A contrast study confirmed the large hernia and also showed that a partial volvulus of the stomach was present - presumably the latter was responsible for the post-prandial vomiting. The patient declined the offer of surgical intervention and wanted to stay on a liquid diet. Gastric volvulus, either partial or complete is quite amenable to laparascopic reduction and repair. (Teague WJ, Ackroyd R, Watson DI, Devitt PG. Changing patterns in the management of gastric volvulus over 14 years. Br J Surg 2000; 87: 358-361).
The contrast study shows the greater curve of the stomach above the lesser curve. A duodenal diverticulum is present and there is calcification of the gallbladder. Patients with so a called 'porcelain gallbladder' are at increased risk of developing carcinoma of the gallbladder.
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