GASTRIC VOLVULUS: TRICKY DIAGNOSIS AND CHALLENGE TREATMENT guezziamel@gmail.com

 

GASTRIC VOLVULUS: TRICKY DIAGNOSIS AND CHALLENGE TREATMENT

1

Algeria

Oral or Poster

Acute gastric volvulus is a rare complication of hiatal hernias. It is described as an abnormal rotation of the stomach around a transverse or longitudinal axis and can be intra-abdominal or intrathoracic. We report two cases of gastric volvulus, followed by a review of the literature.

Two patients were hospitalized for upper digestive obstruction. After imaging investigations and medical resuscitation, surgical treatment was planned

A 52-year-old male complained of epigastric pain, associated with belching and vomiting. On physical examination, epigastric distension, and difficulty to pass a nasogastric tube. Abdomen X-ray revealed a voluminous air-fluid image in the heart era. The scan revealed an intrathoracic gastric volvulus with significant gastric distension, a large mixed hiatal hernia with ascension of left colic angle. Laparotomy confirmed the organoaxial torsion. Reduction of the volvulus with complete reduction of the herniated viscera and closure of the diaphragmatic defect. A 77-year female was admitted with pain in the epigastrium, intolerance to the oral route, and inability to place a nasogastric tube. In CT scan, inverted stomach along the mesenteric axis with mixed hiatal hernia. The patient underwent surgery. Devolvulation of the stomach, restoration to its normal intra-abdominal position and closure of the diaphragmatic defect. The two patients were discharged without any complications on post-op day 5.

Acute gastric volvulus is a rare complication of hiatal hernias. Its clinical presentation is not very specific and its diagnosis is based on radiological exploration. It is an emergency requiring urgent surgical treatment.