A Case of Debilitating Abdominal Pain: Gastric Twist Post Sleeve Gastrectomy

Gastric twist (GT) is a rare and often underdiagnosed condition that requires a high index of suspicion due to its potential to cause significant morbidity if not promptly recognized and managed. Diagnosis typically begins with an upper gastrointestinal (GI) contrast study, which is particularly useful for visualizing the orientation and rotation of the stomach. Endoscopy is usually performed afterward to rule out intraluminal pathology and, in some cases, to confirm the degree of torsion. In select situations, computed tomography (CT) may help identify associated anatomical abnormalities or complications. Management depends on symptom severity and anatomical findings. Medical therapy, including acid suppression and dietary modification, is generally reserved for patients with mild or intermittent symptoms. Endoscopic management, such as metallic stenting, may be attempted in cases of distal sleeve stenosis. However, surgical intervention is often required for patients with persistent, severe, or recurrent symptoms. We report a case of GT diagnosed 10 years after laparoscopic sleeve gastrectomy (LSG), successfully treated with ligamentum teres cardiopexy, resulting in complete symptom resolution.