Introduction
Gastric volvulus is a rare but potentially life threatening condition that is defined by the pathological rotation of the stomach. There are many factors that contribute to the pathophysiology of this condition, for example laxity of the gastric ligaments. Gastric volvulus can be categorized according to the axis of the rotation and may result in an organoaxial, mesenteroaxial, or combined volvulus of the stomach1. This condition can be primary or secondary, with secondary being more common, typically due to its association with paraesophgeal hernias. Approximately 10-20% of gastric volvuli occurs in infants less than one year of age and is often a complication of congenital diaphragmatic defects2. The incidence of gastric volvulus …show more content…
The patient had a review of systems positive for chest pain, shortness of breath and left lower extremity pain. Chest and pelvis X-rays where obtained, which revealed a left hemothorax and multiple pelvic fractures respectively. Computed tomography (CT) of the chest and abdomen were also obtained which further disclosed an incomplete aortic transection, left pneumothorax and a shattered spleen. Due to the radiological findings the patient had a chest tube placed in the trauma bay, and was taken emergently to the operating room for further intervention. In the operating room a thoracic endovascular repair with stent placement was performed for the aortic transection. Simultaneously an exploratory laparotomy with a splenectomy was completed. The patient’s pelvic fractures where repaired one day later. The patient was initially managed post-operatively in the ICU and on post-op day seven was transferred to a surgical floor having advanced to a regular diet. On postoperative day eight the patient began to complain of shortness of breath while speaking, followed by several episodes of emesis. A nasogastric tube was placed without difficulty in response, to recurrent emesis of coffee ground appearing liquid, which produced 3.5 L of gastric fluid. A CT of the abdomen was obtained, showing marked …show more content…
The rare incidence of the gastric volvulus makes its diagnosis difficult in the clinical setting5. While one third of cases have a presentation with acute onset, a chronic presentation can also occur 6. The degree of obstruction as well as the presence or absence of strangulation of the blood supply to the stomach can determine the degree of clinical symptoms5. Acute symptoms include sudden upper abdominal pain. Physical signs of gastric volvulus include distention of the upper abdomen and occasionally can be tympanic to percussion6. With chronic symptoms patients often complain of non-specific upper abdominal pain
Gastric volvulus is a rare but potentially life threatening condition that is defined by the pathological rotation of the stomach. There are many factors that contribute to the pathophysiology of this condition, for example laxity of the gastric ligaments. Gastric volvulus can be categorized according to the axis of the rotation and may result in an organoaxial, mesenteroaxial, or combined volvulus of the stomach1. This condition can be primary or secondary, with secondary being more common, typically due to its association with paraesophgeal hernias. Approximately 10-20% of gastric volvuli occurs in infants less than one year of age and is often a complication of congenital diaphragmatic defects2. The incidence of gastric volvulus …show more content…
The patient had a review of systems positive for chest pain, shortness of breath and left lower extremity pain. Chest and pelvis X-rays where obtained, which revealed a left hemothorax and multiple pelvic fractures respectively. Computed tomography (CT) of the chest and abdomen were also obtained which further disclosed an incomplete aortic transection, left pneumothorax and a shattered spleen. Due to the radiological findings the patient had a chest tube placed in the trauma bay, and was taken emergently to the operating room for further intervention. In the operating room a thoracic endovascular repair with stent placement was performed for the aortic transection. Simultaneously an exploratory laparotomy with a splenectomy was completed. The patient’s pelvic fractures where repaired one day later. The patient was initially managed post-operatively in the ICU and on post-op day seven was transferred to a surgical floor having advanced to a regular diet. On postoperative day eight the patient began to complain of shortness of breath while speaking, followed by several episodes of emesis. A nasogastric tube was placed without difficulty in response, to recurrent emesis of coffee ground appearing liquid, which produced 3.5 L of gastric fluid. A CT of the abdomen was obtained, showing marked …show more content…
The rare incidence of the gastric volvulus makes its diagnosis difficult in the clinical setting5. While one third of cases have a presentation with acute onset, a chronic presentation can also occur 6. The degree of obstruction as well as the presence or absence of strangulation of the blood supply to the stomach can determine the degree of clinical symptoms5. Acute symptoms include sudden upper abdominal pain. Physical signs of gastric volvulus include distention of the upper abdomen and occasionally can be tympanic to percussion6. With chronic symptoms patients often complain of non-specific upper abdominal pain