Presentation
Epigastric pain, abdominal distention with intractable retching but very minimal bilious vomiting
Patient Data
The stomach is twisted along its short axis plane such that the gastro-esophageal junction is inferiorly placed in relation to the pyloro-duodenal junction. The inserted nasogastric tube is seen taking a twist and demonstrating the inferiorly located gastric fundus relative to the pyloro-antrum. The stomach wall show enhancement with contrast without evidence of pneumatosis which excludes ischemia.
The spleen is abnormally placed and lies in an infero-medial location consistent with wandering spleen. The rest of the small and large intestines are of normal caliber.
Tortuous abdominal aorta is noted with calcifications seen within the walls of the iliac branches. Right hydrocele is also noted. Degenerative changes are seen on the demonstrated dorsolumbar spine.
Features are those of mesentero-axial volvulus without evidence of bowel ischemia.
Case Discussion
Of the two types of gastric volvulus described, organo-axial and mesenteroaxial type, the latter is less common and is more common in the pediatric population. This patient is an adult with features of mesenteroaxial volvulus which is a rare occurrence.
One of the clinical presentation of gastric volvulus is inability to pass a nasogastric tube, however this patient came with a nasogastric tube successfully placed, which is also a rare occurrence.
Wandering spleen is an associated feature which is also seen in this case. There is no associated diaphragmatic hernia or evidence of bowel ischemia. The patient was therefore referred for urgent surgical intervention.
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