Incomplete mesentero-axial volvulus of the stomach

Case contributed by Dr Matthew Lukies

Presentation

Anemia with large hiatus hernia. To delineate anatomy.

Patient Data

Age: 75
Gender: Female
  • Preliminary images demonstrate a hiatus hernia with the appearance of two gastric air bubbles, one above and one below the diaphragm
  • The upper and mid esophagus are unremarkable
  • Minor hold up of contrast and tertiary peristalsis in the distal esophagus
  • Mesentero-axial rotation of the stomach with the antrum and pylorus located superiorly within the chest through a large diagphragmatic hiatus, and the cardia and fundus located inferiorly
  • The gastro-esophageal junction appears normal in diameter
  • The stomach is not significantly dilated
  • Contrast solution passes through to the duodenum

Findings are consistent with hiatus hernia and incomplete gastric mesoentero-axial rotation or volvulus (<180°).

Case Discussion

Mesentero-axial rotation or volvulus is less common in the adult population than organo-axial, and is most commonly incomplete (<180°). The complete form of meso-axial volvulus (>180°) is associated with severe obstruction and strangulation.

Barium study findings in this case were consistent with those at endoscopy.

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