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Acute Gastric Volvulus Causing Splenic Avulsion and Hemoperitoneum.
Yana Cavanagh1, Neal Carlin1, Ruhin Yuridullah2
1Department of Gastroenterology, New York Medical College at St. Joseph's Regional Medical Center, Paterson, NJ, USA.
Case Reports in Gastrointestinal Medicine
|May 29, 2018
Summary
Gastric volvulus, a stomach torsion, can be masked by complications like hemoperitoneum. This case highlights the importance of clinical suspicion for diagnosing gastric volvulus despite misleading imaging findings.
Area of Science:
- Gastroenterology
- Radiology
- Surgical Case Report
Background:
- Gastric volvulus is a rare but serious condition involving stomach torsion.
- Complications like hemoperitoneum can obscure the diagnosis of gastric volvulus.
- Borchardt's triad (vomiting, retching, abdominal pain) is a classic presentation.
Observation:
- A 66-year-old female presented with gastric outlet obstruction, hemoperitoneum, and splenic avulsion.
- Initial imaging focused on hemoperitoneum, leading to a missed diagnosis of gastric volvulus.
- Nasogastric tube placement provided symptomatic relief, and endoscopy showed no outlet obstruction.
Findings:
- A repeat CT scan confirmed gastric volvulus by showing stomach repositioning.
- The patient had a history of gastrostomy tube placement, making the recurrence unusual.
- Hemoperitoneum and splenic avulsion were rare co-occurring complications.
Implications:
- This case underscores the need for high clinical suspicion for gastric volvulus, even with confounding factors.
- Radiographic findings can be misleading, necessitating careful clinical correlation.
- Prompt diagnosis and management are crucial for life-threatening gastric volvulus.
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