Gastric volvulus following diagnostic upper gastrointestinal endoscopy: a rare complication

Abstract

Esophagogastroduodenoscopy (EGD) is a commonly used, safe diagnostic modality for evaluation of epigastric pain and rarely its major complications include perforation, haemorrhage, dysrhythmias and death. Gastric volvulus has been reported to complicate percutaneous endoscopic gastrostomy but its occurrence after diagnostic EGD has not yet been reported in literature. The successful management relies on prompt diagnosis and gastric untwisting, decompression and gastropexy or gastrectomy in full thickness necrosis of the stomach wall. A 38-year-old woman presented with epigastric pain and EGD showed pangastritis. Immediately after EGD she developed increased severity of pain, vomiting and abdominal distension. Emergency laparotomy carried out for peritoneal signs revealed eventration of left hemidiaphragm with the stomach twisted anticlockwise in the longitudinal axis. After gastric decompression and untwisting of volvulus, anterior gastropexy and gastrostomy was carried out. Hence, we report this rare complication of diagnostic endoscopy and review the existing literature on the management.

Vólvulo gástrico; presentación clínica de una complicación de cirugía gástrica previa

“…Los vólvulos primarios (también llamados idiopáticos) ocurren por una alteración en las estructuras de fijación gástrica; mientras que los secundarios se desarrollan como consecuencia de alteraciones anatómicas o funcionales del estómago u órganos adyacentes, siendo la asociación más frecuente con hernias diafragmáticas. [3][4][5] En el caso del paciente presentado en este reporte, el vólvulo gástrico se clasificaría como secundario tras la funduplicatura laparoscópica previa, que fungió como alteración anatómica a partir de la cual se desarrolló un eje de rotación.…”

“…El vólvulo mixto es una mezcla de los anteriores. 3,4 El pico de incidencia de esta patología ocurre en la quinta década de la vida y no se han reportado asociaciones con género o raza. 3,5 La forma secundaria es la más frecuente y corresponde hasta 70% de los casos.…”

Midgut Volvulus after Percutaneous Endoscopic Gastrostomy

“… 12 Gas insufflation was also considered a possible trigger in one case of gastric volvulus after an upper endoscopy in a dyspeptic woman. 13 …”

“…Despite the reported cases, no definitive cause-and-effect relationship could be drawn, but bowel inflation, pneumoperitoneum, anesthetics, and bowel mobilization could be involved in the genesis of the volvulus, probably in predisposed patients, such as patients with less fixed visceras. 7 - 13 The possibility of midgut volvulus after PEG placement as a cause of small bowel obstruction must be considered despite the rarity of the diagnosis, to properly refer patients to surgery and avoid serious complications.…”

A Case of Laparoscopic-Assisted Percutaneous Endoscopic Gastrostomy (LAPEG) for Gastric Volvulus

“…These issues are commonly secondary to the inability to transilluminate the abdominal wall. Complex medical issues include the transverse colon flopping over the stomach and gastric volvulus [7, 8].…”