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Comune R, Guida F, Marte G, Diglio D, Nicola R, Bonito G, Tonerini M, Galluzzo M, Scaglione M, Tamburrini S. Gastric outlet obstruction in uncomplicated mesentero-axial gastric volvulus associated to hiatal hernia. Radiol Case Rep 2024; 19:2698-2702. [PMID: 38666144 PMCID: PMC11043781 DOI: 10.1016/j.radcr.2024.03.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 03/03/2024] [Accepted: 03/11/2024] [Indexed: 04/28/2024] Open
Abstract
Gastric volvulus is a rare condition determined by the rotation of one part of stomach around another. Stomach can rotate around its longitudinal or short axis or both. The presentation can be acute, subacute and chronic due to twisting and untwisting andimaging should be performed in the acute phase. MDCT shows high accuracy in thediagnosis and definition of gastric volvulus being the preferred diagnostic test in emergency settings. Gastric volvulus may be associated or determined by pre-existing hiatal hernia and accurate analysis of CT signs may be evaluated on order to differentiate between a stomach in an abnormal position and a volvulus.At CT, a displaced antrum at the same level or cranial to the fundus and a transition point at the pylorus is diagnostic for mesenteroaxial volvulus. We present a case of a 70 years old woman with mesenteroaxial volvulus in hiatal hernia.
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Affiliation(s)
- Rosita Comune
- Division of Radiology, Università degli Studi della Campania Luigi Vanvitelli, Naples, Italy
| | - Francesco Guida
- Department of General and Emergency Surgery, Ospedale del Mare, ASL NA1 Centro, Naples, Italy
| | - Giampaolo Marte
- Department of General and Emergency Surgery, Ospedale del Mare, ASL NA1 Centro, Naples, Italy
| | - Domenico Diglio
- Department of Radiology Hospital of Marcianise, 81025 Marcianise, Italy
| | - Rosano Nicola
- Department of Radiology, Ospedale del Mare, ASL NA1 Centro, Naples, Italy
| | - Giacomo Bonito
- Department of Emergency Radiology-Policlinico Umberto I Hospital, Sapienza University of Rome, Rome, Italy
| | - Michele Tonerini
- Department of Emergency Radiology, Cisanello Hospital, Via Cisanello, Italy
| | - Michele Galluzzo
- Department of Emergency Radiology, San Camillo Forlanini Hospital, Rome, Italy
| | - Mariano Scaglione
- Department of Medicine, Surgery and Pharmacy, University of Sassari, Piazza Università, Sassari, Italy
- Department of Radiology, James Cook University Hospital, Middlesbrough, UK
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2
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McNellage L, Pacheco ZS, Shufflebarger EF. Massive Hiatal Hernia With Acute Gastric Volvulus Masked as a Suspected Food Poisoning: A Case Report. Cureus 2023; 15:e44943. [PMID: 37818520 PMCID: PMC10561523 DOI: 10.7759/cureus.44943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2023] [Indexed: 10/12/2023] Open
Abstract
We describe the case of a 69-year-old female who thought she had "food poisoning", which prompted her visit to the Emergency Department for evaluation of her vomiting and abdominal discomfort. Contrasted computed tomography imaging with contrast of the abdomen subsequently revealed the diagnosis of gastric volvulus, and the patient was promptly taken for surgical intervention. Gastric volvulus is rare and presents with a nonspecific history, exam, and laboratory findings. In the acute care setting, it is important to maintain a high clinical suspicion for this diagnosis, as timely imaging and intervention are crucial to decreasing patient morbidity and mortality.
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Affiliation(s)
- Landon McNellage
- College of Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, USA
| | - Zachary S Pacheco
- Emergency Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, USA
| | - Erin F Shufflebarger
- Emergency Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, USA
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Emergency surgery for hiatus hernias: does technique affect outcomes? A single-centre experience. Updates Surg 2023:10.1007/s13304-023-01482-y. [PMID: 36869223 PMCID: PMC10359210 DOI: 10.1007/s13304-023-01482-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 02/23/2023] [Indexed: 03/05/2023]
Abstract
BACKGROUND Emergency surgery for a hiatus hernia is usually a high-risk procedure in acutely unwell patients. Common surgical techniques include reduction of the hernia, cruropexy then either fundoplication or gastropexy with a gastrostomy. This is an observational study in a tertiary referral centre for complicated hiatus hernias to compare recurrence rates between these two techniques. METHODS Eighty patients are included in this study, from October 2012 to November 2020. This is a retrospective review and analysis of their management and follow-up. Recurrence of the hiatus hernia that mandates surgical repair was the primary outcome of this study. Secondary outcomes include morbidity and mortality. RESULTS In total, 38% of the patients included in the study had fundoplication procedures, 53% had gastropexy, 6% had complete or partial resection of the stomach, 3% had fundoplication and gastropexy and one patient had neither (n = 30, 42, 5, 2,1, respectively). Eight patients had symptomatic recurrence of the hernia which required surgical repair. Three of these patients had acute recurrence and 5 after discharge. 50% had undergone fundoplication, 38% underwent gastropexy and 13% underwent a resection (n = 4, 3, 1) (p value = 0.5). 38% of patient had no complications and 30-day mortality was 7.5% CONCLUSION: To our knowledge, this is the largest single centre review of outcomes following emergency hiatus hernia repairs. Our results show that either fundoplication or gastropexy can be used safely to reduce the risk of recurrence in the emergency setting. Therefore, surgical technique can be tailored based on the patient characteristics and surgeon experience, without compromising the risk of recurrence or post-operative complications. Mortality and morbidity rates were in keeping with previous studies, which is lower than historically documented, with respiratory complications most prevalent. This study shows that emergency repair of hiatus hernias is a safe operation which is often a lifesaving procedure in elderly comorbid patients.
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Muacevic A, Adler JR, Cromer R. Acute Mesenteroaxial Volvulus in the Setting of Chronic Paraesophageal Hernia: A Case Report. Cureus 2023; 15:e34124. [PMID: 36843737 PMCID: PMC9949735 DOI: 10.7759/cureus.34124] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2023] [Indexed: 01/26/2023] Open
Abstract
Hiatal hernia is a common finding in radiologic and gastroenterology evaluations. Here, we present a patient with an uncommon paraesophageal subtype who was managing her hiatal hernia symptoms conservatively and eventually developed the rare complication of mesenteroaxial gastric volvulus. The chronic history of this patient's hiatal hernia with classic complaints suggestive of gastric ischemia prompted clinical suspicion of volvulus. Here, we discuss the initial clinical presentation of this patient, imaging study, and emergent surgical intervention by robot-assisted laparoscopic gastric volvulus reduction, hiatal hernia repair, and Nissen fundoplication. Although the size and axis of rotation of this patient's volvulus made this case challenging, the prompt intervention prevented complications associated with volvulus and ischemia.
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5
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Danushka PGN, Jayasinghe R. A case report on secondary mesentero-axial gastric volvulus. SAGE Open Med Case Rep 2022; 10:2050313X221144198. [PMID: 36569033 PMCID: PMC9772930 DOI: 10.1177/2050313x221144198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 11/22/2022] [Indexed: 12/23/2022] Open
Abstract
Mesentero-axial gastric volvulus is a rare presentation to a surgical casualty unit with sinister complications and significant mortality and morbidity. Clinical assessment should be done with high suspicion in the case of an associated anatomical defect. Accurate diagnosis and timely intervention would drastically reduce morbidity and mortality. The present patient is a 63-year-old male with an acute and chronic presentation of a secondary mesentero-axial gastric volvulus with a large hiatal hernia who underwent open surgical repair with unremarkable postop recovery.
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Affiliation(s)
- PG Nadun Danushka
- PG Nadun Danushka, The National Hospital of Sri Lanka, Colombo 8, Western Province, Sri Lanka.
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6
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Vrba R, Klos D, Kürfurstová D, Špička P. Gastric resection with intrathoracic anastomosis in a hiatal hernia - A case report. Int J Surg Case Rep 2022; 102:107809. [PMID: 36493713 PMCID: PMC9730040 DOI: 10.1016/j.ijscr.2022.107809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 11/26/2022] [Accepted: 11/27/2022] [Indexed: 11/30/2022] Open
Abstract
Severe complication of hiatal hernia with gastric and esophageal necrosis Acute total gastrectomy with esophagojejunoanastomosis via right-sided thoracotomy Simultaneous resection of multiple jejunal diverticula present
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Affiliation(s)
- Radek Vrba
- Department of Surgery, Faculty of Medicine and Dentistry, Palacky University Olomouc, Hnevotinska 976/3, Olomouc 775 15, Czech Republic
| | - Dušan Klos
- Department of Surgery, Faculty of Medicine and Dentistry, Palacky University Olomouc, Hnevotinska 976/3, Olomouc 775 15, Czech Republic
| | - Daniela Kürfurstová
- Department of Clinical and Molecular Pathology, Faculty of Medicine and Dentistry, Palacky University Olomouc, Hnevotinska 976/3, Olomouc 775 15, Czech Republic
| | - Petr Špička
- Department of Surgery, Faculty of Medicine and Dentistry, Palacky University Olomouc, Hnevotinska 976/3, Olomouc 775 15, Czech Republic,Corresponding author at: Department of Surgery, Faculty of Medicine and Dentistry, Palacky University Olomouc, Hnevotinska 976/3, Olomouc 775 15, Czech Republic
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7
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Rajwana Y, Ezeh KJ, Ott W, Spira E. Gastric Volvulus, An Important Yet Commonly Overlooked Etiology of Upper Gastrointestinal Bleeding: A Case Study. Cureus 2022; 14:e26976. [PMID: 35989843 PMCID: PMC9385070 DOI: 10.7759/cureus.26976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2022] [Indexed: 11/12/2022] Open
Abstract
Gastric volvulus is a distinct and uncommon pathology that usually presents with vomiting secondary to gastric outlet obstruction and gastrointestinal bleeding with an association with hiatal hernia. We present a case of a 71-year-old female who presented to the emergency department (ED) with a three-day history of coffee ground emesis. Of note, the patient was recently in the hospital under medical observation two weeks prior, with similar complaints of hematemesis. Chest X-ray revealed a left basilar opacity representing bowel gas suggestive of a hiatal hernia. Intravenous proton pump inhibitors were initiated but due to persistent recurrence of symptoms and progressive discomfort, a computed tomography (CT) of the chest and abdomen was ordered. This revealed a partial gastric volvulus with signs suggestive of vascular compromise of the herniated part of the stomach. She subsequently underwent emergent laparotomy, repair of the hiatal hernia, and partial gastrectomy and gastropexy. Post-surgical biopsy findings showed focal mucosal necrosis and ulceration, focal foveolar hyperplasia, edematous changes, and overall congestion in the submucosal tissue. She was discharged five days later with no complications or recurrence of symptoms.
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8
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Zafar M, Parvin J, Mcwhirter A, Loterh L, Koshi I, Viner T, Watts G, Ofuafor K. Gastric Volvulus: Diagnosis and Successful Endoscopic De-rotation Towards Conservative Management in a Patient With Multiple Comorbidities. Cureus 2022; 14:e26862. [PMID: 35854951 PMCID: PMC9282863 DOI: 10.7759/cureus.26862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2022] [Indexed: 11/18/2022] Open
Abstract
Gastric volvulus is a condition that is not frequently seen in clinical practice and can present with a myriad of symptoms, meaning it can be challenging to diagnose. We present an 82-year-old female attending the emergency department with epigastric pain and coffee ground vomiting on a background of rectosigmoid cancer and a large, complex hiatus hernia. On investigation there was no drop in haemoglobin. However, the chest X-ray showed air-fluid levels and raised the suspicion of gastric volvulus, particularly given her past medical history. The timely organisation of a computed tomogram (CT) scan allowed for prompt decision-making with involvement of surgical colleagues. The patient proceeded to successful conservative management with upper gastroduodenal endoscopy and a de-rotation technique. This case highlights the importance of considering gastric volvulus as a differential diagnosis in those presenting with epigastric pain and vomiting particularly in patients over 50 with a history of large hiatus hernia. This allows for prompt diagnosis and management and avoidance of major complications like gastric mucosal ischaemia.
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9
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Kumar S, Nepal P, Kumar D, Tirumani SH, Nagar A, Ojili V. Twists and turns in acute abdomen: imaging spectrum of torsions and volvulus. Clin Imaging 2022; 87:11-27. [DOI: 10.1016/j.clinimag.2022.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 03/22/2022] [Accepted: 04/11/2022] [Indexed: 11/03/2022]
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10
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Duplan P, Choudhry H, Memon M, Klein D, Ghanekar D. Severe Gastric Mucosal Necrosis Due to Giant Paraesophageal Hernia. Cureus 2022; 14:e24564. [PMID: 35651445 PMCID: PMC9138213 DOI: 10.7759/cureus.24564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2022] [Indexed: 11/05/2022] Open
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Gimenez FY, Takahashi LAR, Oliveira GG, Myaki JY, Inaba ME, Feitosa FPA, Adão D. Hiatus hernia with gastric volvulus and duodenum component: a case report. J Surg Case Rep 2021; 2021:rjab548. [PMID: 34909173 PMCID: PMC8666199 DOI: 10.1093/jscr/rjab548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 11/16/2021] [Indexed: 11/13/2022] Open
Abstract
Gastric volvulus is a rare condition defined as an abnormal stomach rotation around its axis, which usually presents in children under a year or in adults in their fifth decade. Cases over 70-year-old are rare and only 30% of cases of this disease present with mesenteric-axial rotation of the stomach. In this article, we report a rare case of mesenteroaxial gastric volvulus associated with hiatal hernia, in an 88-year-old woman, who presented to the Emergency Department of our institution with bowel obstruction symptoms. The diagnosis could be difficult due to the rarity of the pathology, the patient's age outside the expected incidence age range and the less common mesenteroaxial presentation. This report highlights the importance of the differential diagnosis of gastric volvulus as a cause of intestinal obstruction.
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Affiliation(s)
- F Y Gimenez
- General Surgery, Federal University of São Paulo, Durval Clemente Street, São Paulo, Brazil
| | - L A R Takahashi
- General Surgery, Federal University of São Paulo, Durval Clemente Street, São Paulo, Brazil
| | - G G Oliveira
- General Surgery, Federal University of São Paulo, Durval Clemente Street, São Paulo, Brazil
| | - J Y Myaki
- General Surgery, Federal University of São Paulo, Durval Clemente Street, São Paulo, Brazil
| | - M E Inaba
- General Surgery, Federal University of São Paulo, Durval Clemente Street, São Paulo, Brazil
| | - F P A Feitosa
- General Surgery, Federal University of São Paulo, Durval Clemente Street, São Paulo, Brazil
| | - D Adão
- General Surgery, Federal University of São Paulo, Durval Clemente Street, São Paulo, Brazil
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12
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Hughes M, Huang D, Elbadri S, Falgiani M, Ganti L. Acute Gastric Volvulus in the Setting of a Paraesophageal Hernia With Hemoperitoneum: Emergency Department Diagnosis and Management. Cureus 2021; 13:e20404. [PMID: 35047248 PMCID: PMC8756554 DOI: 10.7759/cureus.20404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2021] [Indexed: 11/09/2022] Open
Abstract
Acute gastric volvulus is an uncommon emergency department (ED) presentation associated with high mortality from gastric ischemia and perforation. The diagnosis of this pathology is complicated by its intermittent symptoms and similarity in presentation to more common disorders encountered in the ED. Assessing for key risk factors, such as the presence of a hiatal hernia, and the use of expeditious imaging modalities, such as bedside radiography and point-of-care ultrasonography, are essential in rapid diagnosis and time-sensitive, definitive surgical intervention.
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13
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Miltiadou K, Chatzidakis A, Lazaridis LD, Oikonomopoulos N, Polymeros D, Papanikolaou IS, Triantafyllou K. Unfolding the stomach in the chest. Endoscopy 2021; 53:E423-E424. [PMID: 33506465 DOI: 10.1055/a-1327-1528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Konstantinos Miltiadou
- Hepatogastroenterology Unit, Second Department of Internal Medicine-Propaedeutic and Research Institute, Medical School, National and Kapodistrian University of Athens, "Attikon" University General Hospital, Athens, Greece
| | - Alexandros Chatzidakis
- Hepatogastroenterology Unit, Second Department of Internal Medicine-Propaedeutic and Research Institute, Medical School, National and Kapodistrian University of Athens, "Attikon" University General Hospital, Athens, Greece
| | - Lazaros-Dimitrios Lazaridis
- Hepatogastroenterology Unit, Second Department of Internal Medicine-Propaedeutic and Research Institute, Medical School, National and Kapodistrian University of Athens, "Attikon" University General Hospital, Athens, Greece
| | - Nikolaos Oikonomopoulos
- 2nd Radiology Department, Medical School, National and Kapodistrian University of Athens, "Attikon" University General Hospital, Athens, Greece
| | - Dimitrios Polymeros
- Hepatogastroenterology Unit, Second Department of Internal Medicine-Propaedeutic and Research Institute, Medical School, National and Kapodistrian University of Athens, "Attikon" University General Hospital, Athens, Greece
| | - Ioannis S Papanikolaou
- Hepatogastroenterology Unit, Second Department of Internal Medicine-Propaedeutic and Research Institute, Medical School, National and Kapodistrian University of Athens, "Attikon" University General Hospital, Athens, Greece
| | - Konstantinos Triantafyllou
- Hepatogastroenterology Unit, Second Department of Internal Medicine-Propaedeutic and Research Institute, Medical School, National and Kapodistrian University of Athens, "Attikon" University General Hospital, Athens, Greece
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14
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Pour Mohammad A, Gholizadeh Mesgarha M, Naderkhani M, Sarmadi R, Zarei E. Acute gastric volvulus following rapid and incomplete chewing of vegetables: A case report. Radiol Case Rep 2021; 17:60-63. [PMID: 34765061 PMCID: PMC8571488 DOI: 10.1016/j.radcr.2021.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 09/30/2021] [Accepted: 10/02/2021] [Indexed: 01/24/2023] Open
Abstract
One of the rare but serious causes of acute abdomen is gastric volvulus. It is considered an emergent surgical condition when it takes place acutely due to the risk of gastric strangulation, gangrene, and perforation. In this study, we introduce a case of a previously healthy young adult patient who presented with sudden severe epigastric and left upper quadrant abdominal pain along with nausea and retching following insufficient mastication and rapid swallowing of large amounts of vegetables. Radiological studies with chest and abdominal X-rays were in favor of acute gastric outlet obstruction and finally, laparotomy confirmed the diagnosis of acute, primary mesenteroaxial gastric volvulus. We postulated a probable justifying mechanism of the presence of a flaccid gastrocolic ligament (found through the laparotomy) besides rapid entrance of great pieces of vegetables into the stomach precipitated instant gastric rotation.
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Affiliation(s)
- Arash Pour Mohammad
- Faculty of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Milad Gholizadeh Mesgarha
- Faculty of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran,Corresponding author.
| | - Mahya Naderkhani
- Emergency Medicine Management Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Rasoul Sarmadi
- Department of Surgery, Firoozabadi hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Elham Zarei
- Ali-Asghar Children Hospital, Department of Radiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
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15
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Türkan A, Yalaza M, Akkurt G, Tolga Kafadar M. Gastric volvulus as a deadly cause of acute abdominal pain: Presentation of three cases. Turk J Surg 2021. [DOI: 10.47717/turkjsurg.2021.4232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Gastric volvulus is usually associated with non-specific abdominal pain and is a very rare condition. Diagnosis of gastric volvulus is difficult because of the lack of specific findings. Its acute form usually requires urgent surgical treatment and is associated with high mortality. In this study, gastric volvulus was diagnosed in three patients who presented with abdominal pain in the emergency department and had non-specific abdominal findings on physi- cal examination. We evaluated this situation, which is rarely seen, on different patients.
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16
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Bujoreanu I, Abrar D, Lampridis S, Date R. Do Poor Functional Outcomes and Higher Morbidity Following Emergency Repair of Giant Hiatus Hernia Warrant Elective Surgery in Asymptomatic Patients? Front Surg 2021; 8:628477. [PMID: 33644111 PMCID: PMC7905348 DOI: 10.3389/fsurg.2021.628477] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 01/18/2021] [Indexed: 11/26/2022] Open
Abstract
Background: Patients with a giant hiatus hernia may present with acute symptoms caused by obstruction, strangulation, perforation and uncontrolled bleeding. Emergency surgical repair has been associated with significant mortality and even greater morbidity. The aim of this study is to investigate the short-term outcomes following emergency repair of giant hiatus hernias. Methods: Data were retrospectively collected for all patients who underwent emergency surgical repair of giant hiatus hernia in a university teaching hospital between 2009 and 2019. Outcomes were short-term morbidity and mortality. We also assessed the association of clinical predictor covariates, including age, ASA class and time to surgery, with risk for major morbidity. Results: Thirty-seven patients with a median age of 68 years were identified. Following surgery, 9 patients (24.3%) developed organ dysfunction that required admission to the intensive care unit. Two patients (5.4%) underwent revision surgery and 3 (8.1%) developed pneumothorax that necessitated chest drain insertion. The commonest complication was pneumonia, which occurred in 13 patients (35.1%). Two deaths (5.4%) occurred within 30 days from surgery. Conclusions: Emergency repair of giant hiatus hernia is associated with high rates of major morbidity, which includes poor functional status, further interventions, repeat surgery, and admission to the intensive care unit. Larger studies are warranted for long-term follow-up to assess post-operative quality of life is needed for asymptomatic patients and for those undergoing emergency surgery.
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Affiliation(s)
- Iulia Bujoreanu
- General Surgery Department, Royal Preston Hospital, Preston, United Kingdom
| | - Daniya Abrar
- General Surgery Department, Royal Preston Hospital, Preston, United Kingdom
| | - Savvas Lampridis
- Thoracic Surgery Department, 424 General Military Hospital, Thessaloniki, Greece
| | - Ravindra Date
- Department of Cancer, The University of Manchester, Manchester, United Kingdom
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17
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Longchamp G, Andres A, Abbassi Z. Gastric necrosis following a hiatal hernia: A case report. Int J Surg Case Rep 2021; 79:108-111. [PMID: 33453464 PMCID: PMC7810906 DOI: 10.1016/j.ijscr.2020.12.092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 12/25/2020] [Accepted: 12/27/2020] [Indexed: 11/25/2022] Open
Abstract
Nasogastric tube decompression if the first-step treatment of gastric volvulus, which can be placed blindly or under endoscopic guidance. Prompt endoscopic or surgical assessment should be conducted when signs of sepsis, perforation, or ischemia are present. Definitive treatment for secondary volvulus is best achieved with hernia reduction, closing of the anatomical defect, and fundoplication. Primary volvulus can be treated with gastropexy alone.
Introduction Gastric volvulus are rare. Complications can be life threatening, including necrosis and perforation. Assessment of mucosal viability is essential, and urgent surgical intervention is mandatory in case of vascular compromise. Presentation of case An 72-year-old female known for a paraesophageal hiatal hernia was admitted at our emergency department with acute abdominal pain. Blood count demonstrated leukocytosis and increased C-reactive protein. Abdominal computed tomography showed a mesenteroaxial gastric volvulus. Urgent upper endoscopy revealed mucosal ischemia, which prompted immediate laparotomy with partial gastrectomy, cruroplasty, and Dor fundoplication. Postoperative course was uneventful. Discussion Gastric volvulus is initially treated with nasogastric tube decompression, but definitive treatment is achieved surgically. When there is an associated hernia, closing the anatomical defect and fundoplication should be performed. Complication such as necrosis is associated with a high mortality, and requires urgent surgical repair. Conclusion Gastric volvulus can be life-threatening. Urgent endoscopic or surgical assessment should be conducted to assess mucosal viability.
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Affiliation(s)
- Gregoire Longchamp
- Division of Digestive Surgery, University Hospitals of Geneva, 1205, Geneva, Switzerland.
| | - Axel Andres
- Division of Digestive Surgery, University Hospitals of Geneva, 1205, Geneva, Switzerland
| | - Ziad Abbassi
- Division of Digestive Surgery, University Hospitals of Geneva, 1205, Geneva, Switzerland
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18
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Vargas Flores J, Vargas Ávila AL, Domínguez Rodríguez JA, De Alba Cruz I, Cortázar Sánchez CA, Hernandez Garrido JM. Total gastrectomy in a case of complicated gastric volvulus: Case report and review of literature. Int J Surg Case Rep 2020; 78:303-306. [PMID: 33388508 PMCID: PMC7797469 DOI: 10.1016/j.ijscr.2020.12.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 12/07/2020] [Accepted: 12/11/2020] [Indexed: 11/26/2022] Open
Abstract
INTRODUCCIóN: Gastric volvulus is characterized by a rotation, in its long or short axis, generating various degrees of obstruction, which can occur acutely or chronically. CASE A 45-year-old female. Refers to the performance of laparoscopic Nissen fundoplication 4 years ago. In December 2018, she presented a recurrence of the symptoms associated with reflux, for which a new laparoscopic fundoplication was performed (outside our medical unit) without eventualities or apparent complications. Six months later, he was admitted to our medical unit due to intolerance to the oral route. Thoraco-abdomino-pelvic tomography reports images suggestive of gastric volvulus and mixed hiatal hernia with protrusion of colon, stomach, duodenum, jejunum and mesenteric vessels, with data suggestive of complication or ischemia of these structures. An emergency operating room was requested to perform an exploratory laparotomy. Gastric volvulus, ischemia and gastric necrosis were observed in the cavity, for which a total gastrectomy and restitution of the intestinal transit were carried out by means of an esophagus-jejunum end-to-side Roux-en-Y anastomosis. DISCUSSION There is no scientific evidence or algorithms described for the management of this condition, according to the management described in the literature, decision-making by our team surgical procedure matches current recommendations. CONCLUSION In accordance with what is described in the literature, we consider it important to carry out a retrospective study that describes the bases for standardizing the management of this complication, and assessing models for conducting prospective multicenter studies that allow the creation of an algorithm and clinical guideline.
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Affiliation(s)
- Julián Vargas Flores
- Department of Surgery, Hospital Regional "General Ignacio Zaragoza" ISSSTE, Ciudad de México, Mexico.
| | - Arcenio Luis Vargas Ávila
- Department of Surgery, Hospital Regional "General Ignacio Zaragoza" ISSSTE, Ciudad de México, Mexico.
| | | | - Israel De Alba Cruz
- Department of Surgery, Hospital Regional "General Ignacio Zaragoza" ISSSTE, Ciudad de México, Mexico.
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Lourenço S, Pereira AM, Guimarães M, Nora M. Gastric Volvulus: A Complication of Hiatal Hernia. Cureus 2020; 12:e11123. [PMID: 33240716 PMCID: PMC7682922 DOI: 10.7759/cureus.11123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Gastric volvulus is a rare but potentially life-threatening condition, with difficult diagnosis. We present a case report of a demented woman aged 65 years that attended the emergency department with epigastric pain and vomiting for the past 10 days. The chest plain revealed a retrocardiac air-filled mass and the abdomino-pelvic computed tomography confirmed the diagnosis of gastric volvulus. The patient was admitted. A nasogastric tube was introduced, antibiotics and parenteric nutrition were started and the patient didn't eat anything. The patient was operated at fifth day of admission by laparoscopy. There weren't signs of gastric necrosis, so the stomach was mobilized for its natural position on abdominal cavity, the hiatal defect was closed and a Nissen fundoplicature was performed. The post operative period was uneventful and the patient was discharged on the third post-operative day, without any complication. This case illustrates a sub acute presentation form of gastric volvulus and a differed minimally invasive approach attending at the patient's clinical stability.
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Affiliation(s)
- Sara Lourenço
- General Surgery, Centro Hospitalar de Entre Douro e Vouga, Santa Maria da Feira, PRT
| | - Ana Marta Pereira
- General Surgery, Centro Hospitalar de Entre Douro e Vouga, Santa Maria da Feira, PRT
| | - Marta Guimarães
- General Surgery, Centro Hospitalar de Entre Douro e Vouga, Santa Maria da Feira, PRT
| | - Mário Nora
- General Surgery, Centro Hospitalar de Entre Douro e Vouga, Santa Maria da Feira, PRT
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20
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Shokraneh K, Johnson J, Cabrera G, Kalivoda EJ. Emergency Physician-Performed Bedside Ultrasound of Gastric Volvulus. Cureus 2020; 12:e9946. [PMID: 32968605 PMCID: PMC7505670 DOI: 10.7759/cureus.9946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Gastric volvulus (GV) is a seldomly encountered life-threatening condition that necessitates rapid diagnosis in the emergency department (ED). The diagnosis of GV is traditionally established with cross-sectional imaging and/or endoscopy with surgical confirmation. The potential role of point-of-care ultrasound (POCUS) as a bedside tool to support the early identification of GV by emergency physicians (EPs) has not been thoroughly investigated. This case report describes the expeditious diagnosis and ED management of acute GV by implementing EP-performed POCUS into critical decision making.
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Affiliation(s)
- Keyon Shokraneh
- Emergency Medicine, Hospital Corporation of America Healthcare West Florida Graduate Medical Education Consortium/University of South Florida Morsani College of Medicine, Brandon Regional Hospital, Brandon, USA
| | - Jordan Johnson
- Emergency Medicine, Hospital Corporation of America Healthcare West Florida Graduate Medical Education Consortium/University of South Florida Morsani College of Medicine, Brandon Regional Hospital, Brandon, USA
| | - Gabriel Cabrera
- Emergency Medicine, Hospital Corporation of America Healthcare West Florida Graduate Medical Education Consortium/University of South Florida Morsani College of Medicine, Brandon Regional Hospital, Brandon, USA
| | - Eric J Kalivoda
- Emergency Medicine, Hospital Corporation of America Healthcare West Florida Graduate Medical Education Consortium/University of South Florida Morsani College of Medicine, Brandon Regional Hospital, Brandon, USA
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21
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Abstract
Gastric volvulus is defined as twisting of the stomach along its long or short axis, a rare clinical entity that can lead to gastric outlet obstruction. Symptoms are typically acute and include retching, abdominal pain, and vomiting. Chronic intermittent manifestations of this entity present a diagnostic challenge as conclusive imaging findings are only apparent during symptomatic periods. Given the disorder’s intermittent nature, a volvulus may resolve before imaging studies can be conducted. We present a rare case of an intermittent organo-axial gastric volvulus that responded to conservative measures.
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22
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ALVER KH, SAĞTAŞ E, AYKOTA MR, YILMAZ S, UFUK F. Mezenteroaksiyal gastrik volvulus: BT bulguları. EGE TIP DERGISI 2020. [DOI: 10.19161/etd.756216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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23
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Ceccarelli G, Pasculli A, Bugiantella W, De Rosa M, Catena F, Rondelli F, Costa G, Rocca A, Longaroni M, Testini M. Minimally invasive laparoscopic and robot-assisted emergency treatment of strangulated giant hiatal hernias: report of five cases and literature review. World J Emerg Surg 2020; 15:37. [PMID: 32487136 PMCID: PMC7268602 DOI: 10.1186/s13017-020-00316-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 05/14/2020] [Indexed: 12/15/2022] Open
Abstract
Background Giant hiatal hernia (GHH) is a condition where one-third of the stomach migrates into the thorax. Nowadays, laparoscopic treatment gives excellent postoperative outcomes. Strangulated GHH is rare, and its emergent repair is associated with significant morbidity and mortality rates. We report a series of five cases of strangulated GHH treated by a minimally invasive laparoscopic and robot-assisted approach, together with a systematic review of the literature. Methods During 10 years (December 2009–December 2019), 31 patients affected by GHH were treated by robot-assisted or conventional laparoscopic surgical approach. Among them, five cases were treated in an emergency setting. We performed a PubMed MEDLINE search about the minimally invasive emergent treatment of GHH, selecting 18 articles for review. Results The five cases were male patients with a mean age of 70 ± 18 years. All patients referred to the emergency service complaining of severe abdominal and thoracic pain, nausea and vomiting. CT scan and endoscopy were the main diagnostic tools. All patients showed stable hemodynamic conditions so that they could undergo a minimally invasive attempt. The surgical approach was robotic-assisted in three patients (60%) and laparoscopic in two (40%). Patients reported no complications or recurrences. Conclusion Reviewing current literature, no general recommendations are available about the emergent treatment of strangulated hiatal hernia. Acute mechanical outlet obstruction, ischemia of gastric wall or perforation and severe bleeding are the reasons for an emergent surgical indication. In stable conditions, a minimally invasive approach is often feasible. Moreover, the robot-assisted approach, allowing a stable 3D view and using articulated instruments, represents a reasonable option in challenging situations.
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Affiliation(s)
- Graziano Ceccarelli
- General Surgery, "San Giovanni Battista" Hospital, USL Umbria 2, Via Massimo Arcamone 1, 06034, Foligno, Italy
| | - Alessandro Pasculli
- Unit of General Surgery "V. Bonomo", Department of Biomedical Sciences and Human Oncology, University of Bari "A. Moro", Polyclinic of Bari, Piazza Giulio Cesare 11, 70124, Bari, Italy.
| | - Walter Bugiantella
- General Surgery, "San Giovanni Battista" Hospital, USL Umbria 2, Via Massimo Arcamone 1, 06034, Foligno, Italy
| | - Michele De Rosa
- General Surgery, "San Giovanni Battista" Hospital, USL Umbria 2, Via Massimo Arcamone 1, 06034, Foligno, Italy
| | - Fausto Catena
- Department of Emergency and Trauma Surgery, Parma University Hospital, Viale Antonio Gramsci 11, 43126, Parma, Italy
| | - Fabio Rondelli
- General Surgery, "San Giovanni Battista" Hospital, USL Umbria 2, Via Massimo Arcamone 1, 06034, Foligno, Italy
| | - Gianluca Costa
- General Surgery, "San Giovanni Battista" Hospital, USL Umbria 2, Via Massimo Arcamone 1, 06034, Foligno, Italy
| | - Aldo Rocca
- Department of Medicine and Health Sciences "V. Tiberio", University of Molise, Via Francesco de Sanctis 1, 86100, Campobasso, Italy
| | - Mattia Longaroni
- General Surgery, "San Giovanni Battista" Hospital, USL Umbria 2, Via Massimo Arcamone 1, 06034, Foligno, Italy
| | - Mario Testini
- Unit of General Surgery "V. Bonomo", Department of Biomedical Sciences and Human Oncology, University of Bari "A. Moro", Polyclinic of Bari, Piazza Giulio Cesare 11, 70124, Bari, Italy
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24
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Mistry V, Gamble EL, Chang J. Adult mesentero-axial gastric volvulus: Case report. J Med Imaging Radiat Oncol 2020; 64:817-820. [PMID: 32441440 DOI: 10.1111/1754-9485.13051] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 04/27/2020] [Indexed: 11/30/2022]
Abstract
Acute gastric volvulus is a rare surgical emergency which can lead to severe complications such as gastric ischaemia and perforation. Gastric volvulus is classified by the axis upon which the stomach rotates into organo-axial and mesentero-axial subtypes, with the former more common in adults. We present an uncommon case of recurrent adult mesentero-axial gastric volvulus and describe the associated radiological findings.
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Affiliation(s)
- Vijay Mistry
- Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Erin Lee Gamble
- Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Jennifer Chang
- Princess Alexandra Hospital, Brisbane, Queensland, Australia
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25
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Kachi A, Chidiac K, Khaled C. A Rare Case of Gastric Volvulus Post Laparoscopic Gastric Greater Curvature Plication. Surg J (N Y) 2020; 6:e24-e27. [PMID: 32051856 PMCID: PMC7012648 DOI: 10.1055/s-0040-1701224] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 11/15/2019] [Indexed: 11/21/2022] Open
Abstract
Gastric volvulus is a rare entity. Its diagnosis remains tricky and challenging. In recent years, the incidence of gastric volvulus has shown a rise in postbariatric surgery patient. Several cases were reported of gastric remnant volvulus post-laparoscopic sleeve gastrectomy and laparoscopic gastric bypass. Laparoscopic gastric greater curvature plication is a new and experimental restrictive technique for weight loss. Several of its complications were reported in the literature but never was a case of volvulus postgastric plication reported, as far as we know. We present this rare case with an atypical presentation and go through similar cases in the literature.
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Affiliation(s)
- Antoine Kachi
- Department of General Surgery, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon.,Department of General Surgery, Lebanese Hospital Geitaoui University Medical Center, Beirut, Lebanon
| | - Khalil Chidiac
- Department of Gastroenterology, Lebanese Hospital Geitaoui University Medical Center, Beirut, Lebanon
| | - Charif Khaled
- Senior Resident, Department of General Surgery, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
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26
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Patel AV, Senatore FJ, Bhurwal A. Epigastric Pain due to Acute Gastric Volvulus. J Emerg Med 2019; 57:e185-e186. [PMID: 31740159 DOI: 10.1016/j.jemermed.2019.09.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 09/09/2019] [Indexed: 11/16/2022]
Affiliation(s)
- Anish Vinit Patel
- Division of Gastroenterology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Frank J Senatore
- Division of Gastroenterology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Abhishek Bhurwal
- Division of Gastroenterology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
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27
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Gray A, Lewis D. Surviving complete gastric infarction in remote Australia. J Surg Case Rep 2019; 2019:rjz133. [PMID: 31086648 PMCID: PMC6507868 DOI: 10.1093/jscr/rjz133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 04/13/2019] [Indexed: 11/29/2022] Open
Abstract
Gastric volvulus is a potentially lethal condition with mortality rates reported up to 50%. The high mortality rate is largely due to the rarer complication of gastric infarction, the diagnosis of which is often difficult. From the small series published, it is known that delays to receiving definitive surgical intervention negatively impacts patient outcomes. We present a case of long-term survival of a 69-year-old man who presented to his local hospital in remote Australia with gastric volvulus and complete gastric infarction. His initial management was delayed as he could not undergo life-saving surgery at his presenting hospital. He was transferred to the regional referral hospital and survived both an upfront damage-control oesophagogastrectomy and then transfer to a metropolitan centre for alimentary tract reconstruction. He was alive and living at home without major postoperative morbidity 12 months later.
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Affiliation(s)
- Andrew Gray
- Department of General Surgery, Tamworth Hospital, Tamworth, NSW, Australia.,Department of Upper Gastrointestinal Surgery, Bankstown-Lidcombe Hospital, NSW, Australia
| | - David Lewis
- Department of General Surgery, Tamworth Hospital, Tamworth, NSW, Australia
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28
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Kyang LS, Srinivasan R, Singh V. Acute gastric volvulus with pneumatosis intestinalis and portal venous gas secondary to hiatus hernia induced gastric outlet obstruction. ANZ J Surg 2019; 89:E582-E583. [PMID: 30675980 DOI: 10.1111/ans.14984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Revised: 10/29/2018] [Accepted: 10/31/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Lee S Kyang
- Department of Surgery, Tamworth Hospital, Tamworth, New South Wales, Australia.,School of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Raj Srinivasan
- Department of Surgery, Tamworth Hospital, Tamworth, New South Wales, Australia
| | - Vivek Singh
- Department of Surgery, Tamworth Hospital, Tamworth, New South Wales, Australia
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29
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CT of Gastric Volvulus: Interobserver Reliability, Radiologists' Accuracy, and Imaging Findings. AJR Am J Roentgenol 2018; 212:103-108. [PMID: 30403524 DOI: 10.2214/ajr.18.20033] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The objective of this study was to identify CT findings and determine interobserver reliability of surgically proven gastric volvulus. MATERIALS AND METHODS This single-center retrospective study included 30 patients (21 women, nine men; mean age, 73 years old) with surgically proven gastric volvulus who underwent preoperative CT and 31 age- and sex-matched control subjects (21 women, nine men; mean age, 74 years old) with large hiatal hernias who were imaged for reasons other than abdominal pain. Two blinded radiologists reviewed the CT images and recorded findings of organoaxial and mesenteroaxial gastric volvulus and ischemia. Interobserver reliability, reader accuracy, sensitivity, specificity, and likelihood ratios of each CT finding were calculated. RESULTS The radiologists were overall 90% accurate (55/61; six false-negatives per reader) in identifying gastric volvulus. Interobserver agreement was substantial (κ = 0.71) for identifying the presence or absence of gastric volvulus. Agreement for most CT findings of gastric volvulus (11/14, 79%) was excellent (5/14, 36%) or substantial (6/14, 43%); the remaining findings showed moderate agreement (3/14, 21%). The most frequent and sensitive CT findings of volvulus with high positive likelihood ratios were stenosis at the hernia neck (reader 1, sensitivity = 80%, positive likelihood ratio = 26.66; reader 2, sensitivity = 77%, positive likelihood ratio = 12.83) and transition point at the pylorus (reader 1, sensitivity = 80%, positive likelihood ratio = 17; reader 2, sensitivity = 70%, positive likelihood ratio = 15). The presence of perigastric fluid or a pleural effusion were significantly more frequent in patients with ischemia at surgical pathology (p < 0.05 in all comparisons, both radiologists). CONCLUSION In our series, CT showed substantial interobserver agreement and fair accuracy in identifying the presence of gastric volvulus.
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30
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Abstract
Intestinal volvulus, regardless of location, is a rare disease process, but one that requires high suspicion and timely diagnosis given the increased incidence of intestinal necrosis and potential mortality. Most patients with intestinal volvulus require some form of surgical intervention. However, over the last few decades, the work-up and management of intestinal volvulus has changed given constant advancements in technology and patient care. Most importantly, however, is recognizing the need for emergent versus more elective surgery because this influences the morbidity and mortality for the individual patient.
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Affiliation(s)
- Zachary M Bauman
- Division of Trauma, Emergency General Surgery and Critical Care Surgery, Department of General Surgery, University of Nebraska Medical Center, 983280 Nebraska Medical Center, Omaha, NE 68198-3280, USA.
| | - Charity H Evans
- Division of Trauma, Emergency General Surgery and Critical Care Surgery, Department of General Surgery, University of Nebraska Medical Center, 983280 Nebraska Medical Center, Omaha, NE 68198-3280, USA
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31
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Brandler JG, Cotter TG, Loftus CG. 61-Year-Old Woman With Episodic Dysphagia and Chest Pain. Mayo Clin Proc 2018; 93:247-251. [PMID: 29258684 DOI: 10.1016/j.mayocp.2017.03.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 03/06/2017] [Accepted: 03/14/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Justin G Brandler
- Resident in Internal Medicine, Mayo Clinic School of Graduate Medical Education, Rochester, MN
| | - Thomas G Cotter
- Resident in Internal Medicine, Mayo Clinic School of Graduate Medical Education, Rochester, MN
| | - Conor G Loftus
- Advisor to residents and Consultant in Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN.
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32
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Merz AE, Preston JF. Gastric Volvulus with Segmental Necrosis Treated with Wedge Resection and Gastrogastrostomy. J Gastrointest Surg 2017; 21:2129-2131. [PMID: 28808950 DOI: 10.1007/s11605-017-3527-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 07/28/2017] [Indexed: 01/31/2023]
Abstract
Ischemic necrosis is a feared complication of acute gastric volvulus, occurring in 11% of patients presenting with the condition and responsible for mortality in 30%. In such cases, there are few well-validated options for surgical reconstruction. We present the case of a 77-year-old woman with intraabdominal mesenteroaxial gastric volvulus with segmental ischemic gastric necrosis who underwent wedge gastrectomy and hand-sewn gastrogastrostomy. She did well postoperatively and experienced no significant gastrointestinal complications. Gastric wedge resection with gastrogastrostomy presents a novel surgical intervention for a rare and highly morbid entity. We hope to add it to the repertoire of surgeons facing acute gastric volvulus complicated by segmental necrosis.
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Affiliation(s)
- Alexa Elizabeth Merz
- Department of General Surgery, Banner University Medical Center, 1441 N. 12th St, 2nd floor, Phoenix, AZ, 85006, USA.
| | - Jennifer Francis Preston
- Department of General Surgery, Banner University Medical Center, 1441 N. 12th St, 2nd floor, Phoenix, AZ, 85006, USA
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33
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Wandering Spleen and Organoaxial Gastric Volvulus after Morgagni Hernia Repair: A Case Report and Review of the Literature. Case Rep Surg 2016; 2016:6450765. [PMID: 27703832 PMCID: PMC5039297 DOI: 10.1155/2016/6450765] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 08/18/2016] [Indexed: 01/25/2023] Open
Abstract
Wandering spleen and gastric volvulus are two rare entities that have been described in association with congenital diaphragmatic hernia. The diagnosis is difficult and any delay can result in ischemia and necrosis of both organs. We present a case of a 13-year-old girl, previously operated on for anterior diaphragmatic hernia and intrathoracic gastric volvulus, that presented to our service for a subdiaphragmatic gastric volvulus recurrence associated with a wandering spleen. In this report we reviewed the literature, analyzing the clinical presentation, diagnostic assessment, and treatment options of both conditions, in particular in the case associated with diaphragmatic hernia.
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34
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Razi K, Light D, Horgan L. Emergency repair of Morgagni hernia with partial gastric volvulus: our approach. J Surg Case Rep 2016; 2016:rjw151. [PMID: 27605660 PMCID: PMC5635609 DOI: 10.1093/jscr/rjw151] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Morgagni hernias are a rare form of congenital diaphragmatic hernias, thus there is paucity in literature about the diagnosis and management of the condition. We report an 83-year-old woman who presented with vomiting and a metabolic acidosis with a previous computed tomography diagnosis of Bochdalek's hernia. Diagnostic laparoscopy revealed a Morgagni hernia containing transverse colon, greater curvature of the stomach and a partial gastric volvulus. The hernia was reduced with the sac untouched, and the defect was closed with a composite mesh using tac fixation. The operation was done successfully in 45 minutes with no complications.
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Affiliation(s)
- Kasra Razi
- Department of General Surgery, North Tyneside General Hospital, North Shields, Tyne and Wear, UK
| | - Duncan Light
- Department of General Surgery, North Tyneside General Hospital, North Shields, Tyne and Wear, UK
| | - Liam Horgan
- Department of General Surgery, North Tyneside General Hospital, North Shields, Tyne and Wear, UK
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35
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Saito S, Hosoya Y, Kurashina K, Matsumoto S, Kanamaru R, Ui T, Haruta H, Kitayama J, Lefor AK, Sata N. Boerhaave's syndrome in a patient with an upside down stomach: A case report. Int J Surg Case Rep 2015; 19:51-4. [PMID: 26710329 PMCID: PMC4756090 DOI: 10.1016/j.ijscr.2015.12.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 12/11/2015] [Accepted: 12/14/2015] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Spontaneous esophageal perforation, or Boerhaave's syndrome, is a life-threating condition which usually requires emergent surgery. An upside down stomach is defined as a gastric volvulus in a huge supradiaphragmatic sac. In general, this condition can result in ischemia and perforation of the stomach. This is the first report of a patient with Boerhaave's syndrome and an upside down stomach. CASE PRESENTATION A 79-year-old woman presented with sudden epigastric pain following hematemesis. Evaluation of the patient showed both an esophageal perforation and an upside down stomach. Surgical drainage and irrigation of the mediastinum and pleural cavities were undertaken emergently. Due to the concurrent gastric volvulus, a gastrostomy was placed to fix and decompress the stomach. The patient had an uneventful hospital course and was discharged. DISCUSSION AND CONCLUSION Boerhaave's syndrome is a rare but severe complication caused by excessive vomiting, due to a sudden elevation in intraluminal esophageal pressure resulting in esophageal perforation. Acute gastric volvulus can result in ischemia and perforation of the stomach, but has not previously been reported with esophageal perforation. The most likely mechanism associating an upside down stomach with Boerhaave's syndrome is acute gastric outlet obstruction resulting in vomiting, and subsequent esophageal perforation. Perforation of the esophagus as well as perforation of the stomach must be considered in patients with an upside down stomach although both upside down stomach and Boerhaave's syndrome are rare clinical entities.
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Affiliation(s)
- Shin Saito
- Department of Surgery, Jichi Medical University, Tochigi, Japan.
| | - Yoshinori Hosoya
- Department of Surgery, Jichi Medical University, Tochigi, Japan.
| | | | - Shiro Matsumoto
- Department of Surgery, Jichi Medical University, Tochigi, Japan.
| | - Rihito Kanamaru
- Department of Surgery, Jichi Medical University, Tochigi, Japan.
| | - Takashi Ui
- Department of Surgery, Jichi Medical University, Tochigi, Japan.
| | - Hidenori Haruta
- Department of Surgery, Jichi Medical University, Tochigi, Japan.
| | - Joji Kitayama
- Department of Surgery, Jichi Medical University, Tochigi, Japan.
| | - Alan K Lefor
- Department of Surgery, Jichi Medical University, Tochigi, Japan.
| | - Naohiro Sata
- Department of Surgery, Jichi Medical University, Tochigi, Japan.
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