Intrathoracic gastric volvulus: an autopsy case report

Area of Science:

• Gastroenterology
• Surgical Pathology

Background:

• Gastric volvulus (GV) is a rare condition, first described in 1866, characterized by stomach twisting exceeding 180 degrees.
• GV can lead to alimentary tract obstruction, visceral ischemia, necrosis, and perforation, with organoaxial and mesenteroaxial being common classifications.
• Risk factors include gastric and diaphragmatic disorders, as well as laxity of gastric ligaments.

Observation:

• The clinical presentation varies from acute and severe to chronic or even asymptomatic.
• While predominantly affecting individuals in their fifth decade, GV can occur in children under 1 year old.
• A fatal case involved a 43-year-old female with a month-long history of symptoms, complicated by herniation of the stomach into the thoracic cavity, pancreatitis, necrosis, and perforation.

Findings:

• Diagnosis was confirmed via thoracic and abdominal axial computed tomography.
• The patient experienced gastric necrosis and perforation, leading to gastroenteric fluid drainage into the mediastinum and left pleural space.
• Despite surgical treatment, the patient's outcome was unfavorable, resulting in death.

Implications:

• Gastric volvulus carries a significant mortality rate, especially when complicated by incarceration and strangulation.
• This case highlights the critical need for prompt diagnosis and surgical treatment of gastric volvulus.
• Raising awareness of GV's severity is essential for timely medical intervention and potentially reducing mortality.