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Delayed diaphragmatic rupture presenting with acute gastric volvulus
J M L Williamson1, R Macleod, A Hollowood
1University Hospitals Bristol NHS Foundation Trust, UK.
Annals of the Royal College of Surgeons of England
|September 24, 2014
Summary
This case report details a rare instance of acute gastric volvulus complicating a diaphragmatic hernia in an elderly male. The condition, presenting after cardiac arrest, proved fatal due to the inability to reduce the gastric volvulus.
Area of Science:
- Gastroenterology
- Trauma Surgery
- Radiology
Background:
- Gastric volvulus is a rare but serious condition.
- Diaphragmatic rupture can lead to delayed complications like gastric volvulus.
- Chronic diaphragmatic hernias present a risk factor for gastric volvulus.
Observation:
- An 82-year-old male presented with out-of-hospital cardiac arrest.
- Imaging revealed acute gastric volvulus and a chronic diaphragmatic hernia with abdominal contents.
- The patient experienced pre-collapse symptoms of retching and epigastric pain.
Findings:
- The patient's history included a motorcycle accident 60 years prior, likely causing the diaphragmatic hernia.
- Nasogastric tube insertion was unsuccessful, fulfilling Borchardt's diagnostic triad for gastric volvulus.
- The patient's critical condition precluded operative or endoscopic reduction of the volvulus.
Implications:
- This case highlights the potential for delayed gastric volvulus after diaphragmatic injury.
- It underscores the diagnostic challenges and poor prognosis of irreducible gastric volvulus.
- Management strategies for elderly patients with acute gastric volvulus require careful consideration.
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