Mesentero-axial gastric volvulus

Case contributed by Dr Maxime St-Amant

Presentation

Epigastric pain.

Patient Data

Age: 75 years
Gender: Female
X-ray

Abdominal & chest x-rays show diffuse distension of bowel loops (colon & small bowel), as well as a hiatal hernia. The hiatal hernia shows an unusual loop configuration. The stomach is distended. There is an air-fluid level at the LUQ. No free air. 

The findings are non-specific. Ileus? gastric volvulus? CT scan is recommended.

CT scan shows a hiatal hernia and a gastric antrum located superior to the esophagogastric junction, associated with significant gastric distension. Moreover, there is a small fluid accumulation near the diaphragmatic hiatus. No free air. The findings are highly suggestive of a mesentero-axial volvulus.

Diagram

These diagrams show the difference in the mechanism of formation in both types of gastric volvulus.

Author: Maxime St-Amant

License: CC-NC-BY-SA

Case Discussion

This patient presented with the classic Borchardt's triad consisting of :

  1. inability to pass a nasogastric tube
  2. severe epigastric pain
  3. retching without vomiting

The diagnosis of mesentero-axial gastric volvulus was confirmed per-operatively, although it can be hard to distinguish from an organo-axial volvulus. 

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