An Unusual Case of Acute Dyspnoea: Acute Intrathoracic Gastric Volvulus with Probable Tension Gastrothorax

Acute gastric volvulus is a rare complication affecting 4% of hiatal hernias. It is described as an abnormal rotation of the stomach around a transverse or longitudinal axis and can be intra-abdominal or intrathoracic. Intrathoracic gastric volvulus can lead to tension gastrothorax, which is defined as the presence of a massive gastric distension in the chest cavity causing a mediastinal shift with haemodynamic instability and a risk of cardiorespiratory arrest. We report a case of intrathoracic gastric volvulus with probable tension gastrothorax. Early diagnosis of gastrothorax with computed tomography and immediate insertion of a nasogastric tube resulted in rapid clinical improvement. Surgical intervention is the treatment of choice.

A RARE CASE OF ACUTE MESENTEROAXIAL GASTRIC VOLVULUS WITH SPLENIC INFARCT

Gastric volvulus is an uncommon clinical entity seen in both adults and pediatric patients. It occurs when the stomach is rotated atleast 180 degrees along its longitudinal or transverse axes. Gastric volvulus may present acutely or may present with intermittent, recurrent and chronic symptoms. In acute presentation, there is risk of strangulation of stomach leading to necrosis , perforation and shock. Hence, prompt diagnosis and treatment of acute gastric volvulus helps to decrease morbidity and mortality. We encountered a case of a 20 year old male patient who presented to the emergency department with acute onset of abdominal pain and distension. Following Contrast Enhanced Computed Tomography and upper GI endoscopy a diagnosis of acute strangulated gastric volvulus with eventeration of left hemidiaphragm was made and patient was posted for emergency laparotomy. Intraoperative ndings included mesenteroaxial volvulus of the stomach with transmural necrosis of the fundus and proximal part of body of stomach along the greater curvature with eventeration of left hemidiaphragm and superior displacement of spleen with infarct of lower part of spleen

A128 ACUTE GASTRIC VOLVULUS DISGUISED AS ACUTE CORONARY SYNDROME.

Background Acute gastric volvulus is a rare but potentially life-threatening condition that warrants emergent assessment. Its clinical presentation may encompass the Borchardt’s triad of vomiting, epigastric pain, and inability to insert a nasogastric tube. However, it can also present as chest pain and is often not cited within the typical differential diagnosis of non-cardiac causes of chest pain. We report the first known case of mesenterico-axial gastric volvulus presenting as acute coronary syndrome with a normal electrocardiogram, complete with radiographic and endoscopic images. Aims To present a case of acute gastric volvulus disguised as an acute coronary syndrome and describe its management. Methods Case report and review of literature. Results A 68 year-old female with history of recent coronary artery bypass graft surgery presented to hospital with sudden onset chest pain radiating to her left shoulder and jaw while having dinner. Initial high sensitivity troponin (normal <9ng/L) was 15ng/L, which increased to a modest peak at 115ng/L. ECG at presentation and through admission consistently showed normal sinus rhythm x 5. She was assessed by Cardiology and given her rising troponin and chest pain, she was treated as a non-ST elevation myocardial infarction with dual antiplatelet therapy. She underwent cardiac catheterization showing distal graft anastomotic site stenosis and was stented x2. Post procedure, her severe retrosternal chest pain recurred. GI was consulted for dysphagia and odynophagia, which was then noted to be present concurrent with her initial chest pain presentation. An urgent CT scan of the abdomen and pelvis revealed acute mesenterico-axial gastric volvulus (Figure 1A), a rarer form of gastric volvulus in the adult population compared to its organo-axial counterpart. After a failed nasogastric decompression, an emergent upper endoscopy was attempted and demonstrated mucosal necrosis (Figure 1B) but was unsuccessful in relieving the volvulus. The patient then underwent overnight surgery, which showed gastric volvulus with contained perforation and 50% necrosis of the stomach with sparing of the cardia and antrum. This resulted in a subtotal gastrectomy, hiatus hernia repair, pyloromyotomy, jejunostomy, and bilateral chest tube insertion. She then recovered in ICU before being successfully discharged home from hospital. Conclusions Acute gastric volvulus can present while disguised as more common causes of chest pain, such as acute coronary syndrome. Those who present with chest pain who also have a history of a large hiatal hernia, or an intrathoracic stomach should be evaluated with gastric volvulus in the differential diagnosis as its prompt management is critical to reduce morbidity and mortality. Funding Agencies None

Acute Gastric Volvulus on Hiatal Hernia

The gastric volvulus is defined as an abnormal rotation of all or part of the stomach around one of its axes, creating the conditions of an upper abdominal obstruction with gastric dilation and risk of strangulation. It is a rare entity that requires a surgical treatment, and its diagnosis is often delayed due to frequently aspecific symptoms. We will describe the observation of a 62 year old patient who presented to the emergency department for acute epigastric pain with dyspnea. The thoracoabdominal CT has demonstrated a stasis stomach on pyloric obstacle evoking a gastric torsion. An upper gastrointestinal endoscopy (EGD) and an upper gastrointestinal contrast made it possible to diagnose an acute gastric volvulus on hiatal hernia. A midline laparotomy was performed with detorsion of the stomach and repair of the hiatal hernia. The patient recovered gradually and was discharged on the sixth postoperative day. Three months after the operation, the patient remained asymptomatic.