Presentation
Hematemesis, severe epigastric abdominal pain.
Patient Data
Mix rolling sliding hiatus hernia with a large portion of the stomach in the abdominal cavity.
Organoaxial gastric volvulus with a distended fundus and distal esophagus. The duodenum and antrum are in a straight line with the antrum in the thoracic cavity.
Solid organs normal.
Colonic diverticulae. No intra-abdominal lymphadenopathy.
Right basal atelectasis, minor left basal pleural thickening and effusion.
Nasogastric tube curled within the large intrathoracic hiatus hernia.
Lungs clear.
Large hiatus hernia.
known large hiatus hernia please can we have a barium swallow & meal follow through to assess esophageal motility
Organoaxial volvulus of the stomach in a large para-esophageal hernia.
The DJ flexure is on the right, but no hold up of contrast into the jejunum.
Case Discussion
Gastric volvulus occurs when the stomach twists on its mesentery. This is an organoaxial type which is the more common in adults and typically occurs in the context of a rolling (para-esophageal) hernia.
The initial presentation was acute and the barium study at a subsequent outpatient appointment.
Barium still rocks in some circumstances. It is much easier to appreciate the entirety of the volvulus than on the CT.