Mesentero-axial gastric volvulus

Case contributed by Dr Maxime St-Amant

Presentation

Retching without vomiting. Acute abdominal pain. Recent surgery for hiatal herniation.

Patient Data

Age: 65 years
Gender: Female

In this patient with a para-esophageal hernia, the esophago-gastric junction is located inferiorly to the gastric antrum, and there is moderate gastric distension. A little quantity of free fluid is seen near the gastric fundus and surrounding the intra-thoracic stomach. The findings are highly suggestive of mesentero-axial gastric volvulus. Surgical consultation is recommended. 

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 also presented the Borchardt triad consisting of :

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

The diagnosis was confirmed per-operatively.

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