Citation Information :
Sharma R, Chauhan A, Sharma B, Bodh V, Aggarwal N, Kaundal A. Intrathoracic Chronic Gastric Volvulus Secondary to Paraesophageal Hernia in a Young Adult: A Case Report. J Postgrad Med Edu Res 2022; 56 (3):131-133.
Introduction: Gastric volvulus is a rare disorder seen commonly in elderly individuals with 50% of cases reported in association with hiatal hernia. Gastric volvulus commonly presents acutely as a surgical emergency, but chronic variant is also well documented.
Case description: We report a case of 35-year-old gentleman, who presented with epigastric pain, postprandial fullness and weight loss of 13 kg in last 6 months. In gastroduodenoscopy, crossing gastroesophageal junction (GEJ) required maneuvering due to abnormal anatomy of stomach and on retroflexion, possible paraesophageal hernia was seen with torsion around scope. CECT abdomen was suggestive of type 3 paraesophageal hernia with gastric volvulus. Patient underwent open laparotomy with repair of hernia and devolvulization of stomach.
Discussion: Gastric volvulus is characterized by abnormal rotation of the stomach around one of its axes leading to foregut obstruction with a risk of strangulation. Treatment involves devolvulization of stomach with correction of underlying pathology. Endoscopic treatment has evolved in recent years with endoscopic devolvulization and percutaneous endoscopic gastrostomy being tried as less invasive approaches, but, most of the patients require surgery either laparoscopic or open.
Conclusion: High index of suspicion is needed to diagnose gastric volvulus, especially chronic variant. Any delay can lead to gastric ischemia and necrosis, and can be fatal.
Grimm MO, Caris C, Witjes WPJ, et al. Reply to Emre Karabay and İlker Tınay's Letter to the Editor re: Treatment of high-grade non-muscle-invasive bladder carcinoma by standard number and dose of BCG instillations versus reduced number and standard dose of BCG instillations: results of the European Association of Urology Research Foundation Randomised Phase III Clinical Trial “NIMBUS”. Eur Urol. In press. https://doi.org/10.1016/j.eururo.2020.04.066. Eur Urol 2020;78(4):e163–e164. DOI: 10.1016/j.eururo.2020.07.004
Teague WJ, Ackroyd R, Watson DI, et al. Changing patterns in the management of gastric volvulus over 14 years. Br J Surg 2000;87(3):358–361. DOI: 10.1046/j.1365-2168.2000.01385.x
Lee HY, Park JH, Kim SG. Chronic gastric volvulus with laparoscopic gastropexy after endoscopic reduction: a case report. J Gastric Cancer 2015;15(2):147–150. DOI: 10.5230/jgc.2015.15.2.147
Ueda S, Orita H, Ito T, et al. A Case of Laparoscopic-Assisted Percutaneous Endoscopic Gastrostomy (LAPEG) for gastric volvulus. Case Rep Med 2019;2019:3468084. DOI: 10.1155/2019/3468084
Bauman ZM, Evans CH. Volvulus. Surg Clin North Am 2018;98(5): 973–993. DOI: 10.1016/j.suc.2018.06.005
Naim HJ, Smith R, Gorecki PJ. Emergent laparoscopic reduction of acute gastric volvulus with anterior gastropexy. Surg Laparosc Endosc Percutan Tech 2003;13(6):389–391. DOI: 10.1097/00129689-200312000-00009
Katkhouda N, Mavor E, Achanta K, et al. Laparoscopic repair of chronic intrathoracic gastric volvulus. Surgery 2000;128(5):784–790. DOI: 10.1067/msy.2000.108658