Gastric volvulus with perforation
3 day history of haematemesis and dark brown stool. Was brought to the emergency department with confusion and ongoing haematemesis.
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Large amount of free intraperitoneal fluid and air and the findings are consistent with perforation of hollow viscus. The findings are most likely in keeping with perforation of peptic ulcer. Large incarcerated hiatal hernia. Marked gastric distention with gas fluid levels in the stomach consistent with gastroparesis or some gastric outlet obstruction which would be consistent with perforated peptic ulcer.
The patient was taken for an emergency laparotomy which revealed a large perforated gastric volvulus. This was reduced from the mediastinum and the hiatal defect sealed. Non viable areas of the stomach including all sites of perforation were resected to healthy bleeding edges and closed. The patient was discharged from hospital after a prolonged recovery after 28 days.