Percutaneous Endoscopic Gastrostomy as Definitive Treatment for Gastric Volvulus in a 94-Year-Old High-Risk Surgical...

Gastric volvulus is an uncommon condition characterized by abnormal rotation of the stomach around one of its anatomical axes. Its diagnosis can be challenging because of its low incidence and nonspecific clinical presentation, particularly in elderly patients, and it may occur in association with a hiatal hernia. Delayed diagnosis may result in serious complications, including ischemia and perforation. Management should be individualized according to patient characteristics and surgical risk. We report the case of a 94-year-old woman with multiple comorbidities, including cardiovascular disease, chronic kidney disease, and long-term anticoagulant therapy, who presented with acute abdominal pain, abdominal distension, nausea, and hematemesis. CT revealed findings consistent with gastric volvulus without evidence of perforation. Given her elevated surgical risk, therapeutic endoscopy was performed, including gastric decompression, endoscopic reduction of the volvulus, and placement of a percutaneous endoscopic gastrostomy (PEG) for gastric fixation. The patient experienced immediate resolution of symptoms, with no procedure-related complications, and remained free of recurrence during 12 months of follow-up. This report highlights the successful use of endoscopic reduction followed by PEG as a long-term management strategy for gastric volvulus in a frail, high-risk surgical patient. It underscores the potential role of this minimally invasive approach in carefully selected patients who are not candidates for definitive surgical repair.