Acute Intrathoracic Gastric Volvulus due to Diaphragmatic Hernia: A Rare Emergency Easily Overlooked

Kim, Hyung Hun; Park, Seun Ja; Park, Moo In; Moon, Won

doi:10.1159/000328444

Cited by 15 publications

(8 citation statements)

References 11 publications

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“… 5 Acute cases may be misdiagnosed as a nonsurgical gastrointestinal issue. 2 Acute cases are a surgical emergency since the abnormal rotation can result in gastric outlet obstruction, vascular compromise leading to necrosis (as seen in our case), or even perforation. While necrosis and perforation are uncommon complications due to collateral circulation, their development is associated with mortality rates up to 60%.…”

Section: Discussionmentioning

confidence: 72%

Acute gastric volvulus: a deadly but commonly forgotten complication of hiatal hernia

Imperatore¹,

Olivieri²,

Vincentelli³

2016

ACR

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Gastric volvulus is a rare condition resulting from rotation of the stomach beyond 180 degrees. It is a difficult condition to diagnose, mostly because it is rarely considered. Furthermore, the imaging findings are often subtle resulting in many cases being diagnosed at the time of surgery or, as in our case, at autopsy. We present the case of a 76-year-old man with an extensive medical history, including coronary artery disease with multiple bypass grafts, who became diaphoretic and nauseated while eating. His presumptive diagnosis at arrival to the hospital was an acute coronary event; however, his initial cardiac work-up was negative. A computed tomography scan revealed a type III hiatal hernia. The following day, after consistent complaints of nausea and episodes of nonbloody emesis, he suddenly became hypotensive, tachycardic and had an episode of coffee-ground emesis. Subsequently, the patient's condition suddenly deteriorated and resuscitation attempts were unsuccessful. The autopsy revealed a partially sliding hiatal hernia, which was consistent with the radiologic impression. Additionally, a gastric volvulus was present with extensive, focally transmural necrosis involving the body/fundus. Gastric volvulus is a rare entity with variable, nonspecific clinical presentations, which requires a high level of suspicion for radiologic diagnosis. Acute cases have a high mortality rate and require emergency surgery. This case highlights the value of autopsy in the diagnosis of unsuspected cases of gastric volvulus when death occurs prior to surgical intervention.

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Section: Discussionmentioning

confidence: 72%

Acute gastric volvulus: a deadly but commonly forgotten complication of hiatal hernia

Imperatore¹,

Olivieri²,

Vincentelli³

2016

ACR

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“…Nissen and Allison techniques) [13][14][15]. Other procedures that are less commonly associated with gastric volvulus include left nephrectomy, splenectomy, and esophogastrectomy [16].…”

Section: Discussionmentioning

confidence: 99%

“…2017;7(1-2): [15][16][17][18][19] around itself or other structures [16]. Gastric volvulus occur relatively infrequently compared to those found in other locations and their pathophysiology is also unique by comparison [16].…”

Section: Discussionmentioning

confidence: 99%

Bockdalek Hernia With Gastric Volvulus With Ischemia in An Adult: A Case Report

2017

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We present an interesting case of a 73-year-old female who presented to the emergency department (ED) with complaints of abdominal pain for the past few days. Patient admitted history of "stomach problems" for the past few years with similar attacks every 3 -4 months and attributed this to her "gallbladder". After her dinner the night before, she started experiencing intense abdominal pain, which prompted her to come to the ED for evaluation. A portable chest X-ray was acquired which showed herniation of the gas-distended stomach overlying the left lung base. CT scan with IV contrast was then performed which confirmed a left-sided diaphragmatic hernia containing the antrum of the dilated stomach but the antrum was twisted to the left of the esophagogastric (EG) junction. There was pneumatosis in the wall of the caudal aspect of the gastric body, suggestive of ischemia. The patient underwent emergent exploratory laparotomy, derotation, partial gastrectomy and gastrostomy where she was found to have an adult Bockdalek hernia on the left side. We discuss this rare case and review relevant literature.

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“…Four types have been described: sliding (type I, where the cardia slides upwards into the mediastinum), paraoesophageal (type II, bulging of the anterior wall or more of the stomach into the mediastinum with preservation of the gastro-oesophageal junction), combined (type III, which combines features of I and II) and giant paraoesophageal (type IV, where more than half of the stomach and occasionally other abdominal organs are located in the mediastinum). Gastric volvulus can cause sudden deterioration in patients with long-standing giant paraoesophageal herniae 2. If left untreated, these patients can also suffer from severe reflux, occult gastrointestinal blood loss due to linear gastric ulcers (Cameron ulcers), intrathoracic incarceration, strangulation or perforation 3 4.…”

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confidence: 99%