A Case of Laparoscopic-Assisted Percutaneous Endoscopic Gastrostomy (LAPEG) for Gastric Volvulus

Acute gastric volvulus: A rare case report and literature review

Introduction and importance

Gastric volvulus is the abnormal gastric rotation upon itself. It carries a considerable risk for gastric strangulation which may lead to gangrene and perforation, which can be fatal. It commonly presents with non-specific and vague abdominal symptoms making prompt diagnosis and management imperative. This is a case report describing a case of acute organo-axial gastric volvulus.

Case presentation

A 74-year-old female, with no comorbidities, presented to our department with non-specific abdominal symptoms. Gastric outlet obstruction was suspected. The patient was reviewed by the gastroenterologist and was offered an urgent upper endoscopy. The upper endoscopy findings described a gastric volvulus, and a Computed Tomography (CT) scan was done to confirm the diagnosis. The patient underwent exploratory/diagnostic laparoscopy and successful reduction and fixation followed. There was no evidence of tissue compromise or ischemia. The patient was discharged on post-operative day 4 following an unremarkable postoperative course.

Clinical discussion

Acute gastric volvulus is a surgical emergency which can be associated with a high morbidity and mortality, if complications occur. The most important factor in diagnosing acute volvulus of the stomach is a high index of suspicion of the clinical symptoms and should be confirmed by imaging. Contrast enhanced computed tomography (CT) scan is the preferred imaging modality. Urgent surgical intervention is needed to prevent potentially fatal complications.

Conclusion

Acute Gastric Volvulus is rare and carries the risk of significant morbidity and mortality. Prompt recognition and treatment is required to prevent complications.

•

Acute gastric volvulus is a rare potentially life-threatening condition.

•

Prompt diagnosis and treatment is vital to improve patient outcome.

•

Contrast enhanced Computed Tomography is the preferred imaging modality used to confirm the diagnosis of gastric volvulus.

•

Surgical repair is the treatment of choice.

Let's (Not) Twist Again: Laparoscopic-Assisted Percutaneous Endoscopic Gastrostomy in Paediatric Gastric Volvulus

INTRODUCTION

In the setting of intermittent abdominal pain accompanied by gastro-intestinal obstruction, gastric volvulus should be suspected.

AREAS COVERED

A 10-year-old girl was admitted to our hospital for intermitted abdominal pain associated with recurrent non-bilious vomiting and acute weight loss. The radiological images performed at the district general hospital were reported as negative. After careful review of the imaging, a gastric volvulus was suspected. Exploratory laparoscopy confirmed the diagnosis; laparoscopic-assisted percutaneous endoscopic gastrostomy was performed. The postoperative upper gastro-intestinal study showed stomach in its normal shape and position.

EXPERT COMMENTARY

Gastric volvulus is a potential life-threatening condition with a good outcome when promptly recognized. Laparoscopic-assisted percutaneous endoscopic gastrostomy is a safe and curative procedure in the case of suspected gastric volvulus, avoiding the need for a secondary procedure. In pediatric patients, it facilitates direct inspection of the stomach and abdominal cavity, reducing the need for a second procedure. This procedure may emerge as a 'gold standard' for gastric volvulus treatment.