Presentation
Asymptomatic. Presenting for a pre-bariatric surgery study.
Patient Data
Two images from a single contrast barium upper GI. On the first erect/standing image, the contrast spills over the lesser curvature into the distal stomach... like a "cascade." The second supine image allows you to see the overall orientation of the stomach and small bowel. The duodenum has been pulled toward the left hemiabdomen along with the stomach.
Case Discussion
"Cascade stomach" is an uncommon variant that can be seen during an upper GI study. It can be confused with a volvulus but is nowhere near as serious. In the cascade stomach, no twisting around the gastric mesenteries has occurred. Instead, the greater curvature has been drawn superiorly for one reason or another, and ingested barium spills over the lesser curvature into the distal stomach (as in the first image). For this particular patient, an elevated left hemidiaphragm has caused the elevation in his greater curvature.
A cascade stomach can make an upper GI study more challenging than usual since the patient has to be moved into positions that better allow passage of the barium around/over the cascade. One might think that this relative delay of bolus passage would cause obvious symptoms as well, but whether it does or not is debated. It is important, however, for a surgeon to know about it before performing a bariatric procedure.