A 63-year-old man with a history of hiatal hernia presented to the emergency department with vomiting and abdominal discomfort.
The physical examination showed an acceptable general state of health, dysphagic fever, abdominal tenderness, diffuse pain in the upper abdomen and hemiparesis; percussion was tympanic in the lower limbs.
A discrete leukocytosis (11760/μl) with 90% neutrophils and a plasma urea of 55 mg/dl were observed in the anteroposterior chest X-ray and in the simple abdomen a large gastric internal level was observed.
An air bubble is also identified in the lower mediastinum.
A nasogastric tube was placed through continuous aspiration which drained abundant amount of gas and 3 gastric contents, achieving a rapid relief of symptoms.
A barium study was subsequently performed which showed a large paraesophageal hernia and mixed gastric volvulus.
The patient underwent elective surgery, performing a reduction and resection of the hernia sac, closure of the defect diaphragism and Nissen fundoplication.
1.
Gastric volvulus is associated with diaphragmatic defects in two thirds of cases.
Other factors include diaphragmatic paralysis, neoplasia or gastric ulcer, and compression by abdominal mass.
Acute presentation is an emergency and, as a first step, nasogastric tube obstruction should be attempted.
If there are no signs of ischemia and the type of volvulus allows, endoscopic reduction of torsion can be attempted.
In the event of ischemia, surgical intervention should be performed, consisting of reduction of the hernia sac and repair of the defect defect defect fracture.
Gastropexy or gastrostomy should also be performed to fix the stomach in its anatomical position.
Partial or total gastrectomy is indicated in the presence of necrosis or neoplasia.
