Mesentero-axial gastric volvulus

Case contributed by Dr Maxime St-Amant


Epigastric pain.

Patient Data

Age: 75
Gender: Female

Abdominal & chest x-rays shows a 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 distented. 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 esophago-gastric 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.

Annotated image

Case Discussion

This patient presented with the classic Borchardt 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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Case information

rID: 19256
Published: 21st Aug 2012
Last edited: 14th Aug 2019
Inclusion in quiz mode: Included

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