Lethal mechanisms in gastric volvulus

Area of Science:

• Gastroenterology
• Pulmonology
• Pathology

Background:

• Gastric volvulus is a rare condition where the stomach twists on itself.
• It typically leads to gastric ischemia, necrosis, perforation, and peritonitis, often resulting in hypovolemic shock or death.
• Severe kyphoscoliosis and immobility, as seen in cerebral palsy, are risk factors.

Observation:

• Autopsy revealed a 55-year-old woman with severe cerebral palsy and a wheelchair-bound status.
• Marked gastric distention due to volvulus was observed, with the stomach viable but filled with air and fluid.
• This distention caused significant upward displacement of the diaphragm, compressing the left lung and shifting the mediastinum.

Findings:

• No evidence of gastric perforation, ischemic necrosis, or peritonitis was found.
• Histology confirmed gastric viability, and biochemistry ruled out dehydration.
• The primary cause of death was identified as respiratory compromise due to thoracic organ compression.

Implications:

• This case presents an alternative lethal mechanism for acute gastric volvulus, emphasizing respiratory compromise over typical vascular compromise.
• It underscores the importance of considering mechanical compression in patients with pre-existing thoracic deformities or immobility.
• Further research into the biomechanics of gastric volvulus in patients with spinal deformities is warranted.