Mesentero-axial gastric volvulus (pregnancy)

Case contributed by Dr Hoe Han Guan

Presentation

Severe epigastric pain and recurrent vomiting for 2 days. Pregnant at 26 weeks of gestation.

Patient Data

Age: 25 years
Gender: Female

Chest radiographs (with and without Ryles feeding tube) showed raised left hemidiaphragm. Left mediastinal and retrocardiac air-fluid level. Ryles feeding tube curled within the left mediastinal and retrocardiac air-fluid level.

The abdominal radiograph showed an air-filled distended stomach. No bowel loops dilatation or pneumoperitoneum.
Singleton fetus skeleton.

The gastro-esophageal junction is situated below the esophageal hiatus and below the pyloro-duodenal junction. Gastric antrum is displaced above the gastro-esophageal junction. The gastric antrum and pylorus are superior to the fundus and proximal body of the stomach. Beaking appearance of the pylorus with the duodenum appears collapsed. The gastric wall is not thickened.

No pneumoperitoneum. No bowel loops dilatation.

Minimal left pleural effusion.

Gravid uterus with singleton fetus.

Case Discussion

Radiological features are more suggestive of gastric volvulus (mesentero-axial type-rotation around the short axis). Another subtype is organo-axial (rotation around the long axis).

Patients may present with the classic triad of Borchardt (severe sudden epigastric pain, intractable retching, and inability to pass Ryles feeding tube). This patient just presented with severe epigastric pain.

Surgical repair is the mainstay of treatment which includes gastropexy and stomach detorsion.

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