Presentation
Presented with severe epigastric pain and retching without vomiting.
Patient Data
Age: 25 years
Gender: Female
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A large air-fluid level is seen in projection of the right hilum of retrocardiac location on the right lateral view with indistinct right hemidiaphragm. The gastric pouch is not visible under the left hemidiaphragm.
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The barium meal demonstrates
- a hiatal hernia with an intrathoracic herniation of stomach and reversal of the greater and lesser curves suggestive of an organo-axial volvulus
- the antrum is above the gastro-oesophageal junction; stomach appears upside-down with the antrum and pylorus superior to the fundus and proximal body suggests also an associated mesentero-axial volvulus
Case Discussion
The chest radiographs and barium meal are suggestive of a combined gastric volvulus associating both organo-axial, and mesentero-axial volvulus which is considered as the third rarest form of gastric volvulus 1.
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