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 22 June 2018

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GastroenterologyStomach & duodenum

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Gastric volvulus.
An 84-year old woman admitted with a 48-hour history of vomiting and constipation. Over the previous 12 hours her lower abdomen had become distended. On examination, she was unwell and in pain. She was dehydrated and the most obvious abnormality was a tender swelling in the lower abdomen. The swelling was dull to percussion. Clinically, the swelling had the appearances of an ovarian cyst.

The CT scan in saggital section shows the stomach in the upper and lower abdomen. The CT scan findings were a complete surprise and the patient therefore proceeded to endoscopy - after an attempted passage of a nasogastric tube failed to get into the stomach. The cardia was negotiated with difficulty and 3.5 L of gastric gastric contents were aspirated. The mucosa was ischaemic and necrotic in places. The pylorus could not be seen.

A contrast study was performed. This showed a total obstruction of the Gastric outlet at the level of the gastric antrum. There was a deformtiy in the mid body of the stomach, with the appearances of an organoaxial volvulus.

A subsequent contrast study confirmed the complete obstruction of the stomach. The patient underwent at attempted laparoscopic correction of the problem. The proximal third of the stomach was impacted in the oesophageal hiatus, necessitating open reduction and repair. It appeared that the greater curve of the stomach had volved anteriorly and somehow become incorporated in this paraoesophageal hernia.


Peter Devitt, Adelaide, Australia

Gastric volvulus.

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