case_images: PMC5039297_01
case_images: Anteroposterior (a) and lateral (b) projections of the abdominal X-ray. The distended stomach (black arrows) occupies epigastrium and mesogastrium; air-fluid level is present in the gastric fundus.
case_images: CRIS2016-6450765.001.jpg
case_images: PMC5039297_01_CRIS2016-6450765.001.jpg
case_images: fig1
case_images: At admission, a chest and abdominal X-ray was performed finding a severe gastric distension with an air-fluid level and normal diaphragmatic profile (Figure 1).
case_images: (a) Ultrasonography. The spleen is displaced caudal to the lower pole of the left kidney (yellow arrow). (b) Color Doppler ultrasound examination reveals a turbulent flow in splenic artery secondary to revascularization.
case_images: CRIS2016-6450765.002.jpg
case_images: PMC5039297_01_CRIS2016-6450765.002.jpg
case_images: fig2
case_images: The abdominal ultrasound showed a very mobile spleen displaced lower and medially; at the Doppler evaluation, the spleen vascular flow was present with increased turbulence (Figure 2).
case_images: CT scan with oral and intravenous contrast. CT scanogram (a), axial CT scan (b), and sagittal reconstruction (c) show the contrast-filled distended stomach, due to an organoaxial gastric volvulus. The coronal reconstruction (d) reveals a displaced spleen with hypoperfusion of the upper pole (yellow arrow).
case_images: CRIS2016-6450765.003.jpg
case_images: PMC5039297_01_CRIS2016-6450765.003.jpg
case_images: fig3
case_images: These features were corroborated by the oral and intravenous contrast CT scan (Figure 3), which showed a subdiaphragmatic organoaxial gastric volvulus.
case_images: Intraoperative findings: the stomach is rotated with the displacement of the cardia under the pyloric level (a); moreover, the spleen is rotated medially and displaced in the left flank (b).
case_images: CRIS2016-6450765.004.jpg
case_images: PMC5039297_01_CRIS2016-6450765.004.jpg
case_images: fig4
case_images: At surgery, we found a organoaxial gastric volvulus with the displacement of the cardia under the pyloric level (Figure 4(a)); moreover, we noticed a wandering spleen located in the left flank with the absence of short gastric vessels and both gastrosplenic and gastrophrenic ligaments (Figure 4(b)); the hiatal foramen and the diaphragm were normally conformed.
case_images: The splenopexy is performed by creation of a retroperitoneal pocket (a) and fixation of the spleen with nonabsorbable sutures mounted on small Teflon pledgets (b).
case_images: CRIS2016-6450765.005.jpg
case_images: PMC5039297_01_CRIS2016-6450765.005.jpg
case_images: fig5
case_images: Teflon pledgets (Figure 5).