A Twist in the tale-Impeding Gastric volvulus?

Gastric volvulus is a rare but potentially life-threatening condition characterized by abnormal rotation of the stomach upon its axis. It often presents with nonspecific symptoms such as epigastric pain, nausea, and vomiting, making diagnosis challenging. This case highlights the complexity of managing a 61-year-old female with a history of cyclic vomiting syndrome/functional dyspepsia, chronic gastroesophageal reflux disease (GERD) with reflux esophagitis and hiatal hernia, who underwent laparoscopic repair with DOR fundoplication and gastropexy. Despite initial relief of acid reflux symptoms, she continued to experience recurrent hospital admissions due to persistent symptoms. Subsequent evaluation revealed gastroparesis, leading to admission for botulinum toxin injection of the pylorus. Further investigation via esophagogastroduodenoscopy (EGD) revealed luminal twisting in the middle portion of the gastric body, raising concern for volvulus. With surgery, recent Botox injection, uncontrolled GERD, and a hiatal hernia, the patient had multiple risk factors. This case underscores the diagnostic challenges and clinical complexity associated with gastric volvulus, emphasizing the importance of prompt recognition. The use of endoscopy as a therapeutic and diagnostic tool is crucial. It helps de-rotating the stomach, allowing installation of a nasogastric tube if previously not possible. The definitive therapies are laparoscopic hernial repair and anterior abdominal wall gastropexy with percutaneous endoscopic gastrostomy (PEG) tubes [1] [2] [3] [4].

Publication History

Article published online:
27 March 2025

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