Sleeve gastrectomy for acute gastric volvulus: a salvage surgery

Gastric volvulus is a rare but potentially fatal condition in which the stomach rotates along its vertical or horizontal axis. It can present with acute symptoms such as abdominal pain, distension, and retching without emesis, or with chronic, nonspecific symptoms. Volvulus may lead to closed-loop obstruction, ischemia, and perforation. Early diagnosis can be challenging owing to nonspecific symptoms, and delays in treatment may result in gastric necrosis requiring resection.

We present the case of a 64-year-old man with acute, severe epigastric pain and abdominal distension experienced for 1 day. His abdomen was tense and tender on palpation, indicating the need for urgent surgical intervention. Emergency laparotomy revealed organoaxial gastric volvulus with knotting at the gastroesophageal junction and antro-pyloric region, leading to closed-loop obstruction and ischemia of the greater curvature. After derotation, the necrotic segment was resected via a sleeve gastrectomy, and gastropexy was performed.

A high index of suspicion with timely intervention is key to the management of acute gastric volvulus. Management includes derotation of the volvulus and abdominal wall gastropexy in non-ischemic cases or gastrectomy in cases of gastric ischemia.