Acute Gastric Volvulus in the Setting of a Paraesophageal Hernia With Hemoperitoneum: Emergency Department Diagnosis and Management

Abstract

Acute gastric volvulus is an uncommon emergency department (ED) presentation associated with high mortality from gastric ischemia and perforation. The diagnosis of this pathology is complicated by its intermittent symptoms and similarity in presentation to more common disorders encountered in the ED. Assessing for key risk factors, such as the presence of a hiatal hernia, and the use of expeditious imaging modalities, such as bedside radiography and point-of-care ultrasonography, are essential in rapid diagnosis and time-sensitive, definitive surgical intervention.

Acute Mesentero-Axial Gastric Volvulus in the Setting of a Paraesophageal Hernia: A Rare Case Report

“…3,4 Seventy-percent of acute gastric volvulus cases demonstrate Borchardt's triad of epigastric pain, retching with emesis, and the inability to pass a nasogastric tube. 1,3,6,[8][9][10][11][12][13][14] Other symptoms include radiation of the epigastric pain to the back, neck or chest, dysphagia, vomiting, and abdominal distention. 5,6 Complications include strangulation leading to ischemia, necrosis, and gangrene along with the risk of perforation, ulceration, and hemorrhage.…”

“… 1 , 3 , 6 , 8 - 14 Other symptoms include radiation of the epigastric pain to the back, neck or chest, dysphagia, vomiting, and abdominal distention. 5 , 6 Complications include strangulation leading to ischemia, necrosis, and gangrene along with the risk of perforation, ulceration, and hemorrhage. 3 Due to the rich blood supply of the stomach, strangulation and subsequent ischemia only occurs at a rate of 5% to 28%.…”

“… 5 Patients often present acutely with epigastric pain, nausea, and vomiting, preceded by violent retching. 6 If not detected early, a gastric volvulus may progress to a closed-loop obstruction causing gastric strangulation with ischemia and necrosis; 2 thus a prompt diagnosis is imperative. Herein, we present a very rare case of an acute mesentero-axial gastric volvulus reduced with a nasogastric tube.…”