Intrathoracic Gastric Volvulus: A Case Report and Review of Literature

Abstract

Background: A volvulus has been defined as a rotation of a hollow organ more than 180 degrees around its axis leading to an obstruction of variable degrees, ischemia, perforation, and necrosis. Gastric volvulus, in particular, is an uncommon entity, associated with high mortality (ranging between 30-50%). Herein, we report a case of strangulated paraesophageal hernia complicated by intrathoracic gastric volvulus, along with summarizing pertinent literature. Case Presentation: A 61-year-old, morbidly obese female, who is known to have diabetes mellitus, hypertension, and glucose-6-phosphate dehydrogenase deficiency, presented with epigastric abdominal pain. The pain onset was associated with nausea, vomiting, and heartburn. Computed tomography scans of the chest and abdomen confirmed the diagnosis of mesentro-axial gastric volvulus secondary to a strangulated paraesophageal hernia. the condition was managed as a surgical emergency where the herniating abdominal organs were placed back into the abdominal cavity and the hiatal defect was approximated with simple stitches. Conclusion: Gastric volvulus remains a diagnostic challenge due to its rarity and its unspecific symptomatology. The presence of Borchardt’s triad should raise the suspicion of underlying gastric volvulus. A computed tomography scan is considered to be the gold standard diagnostic modality and endoscopic decompression is recommended before the definitive surgical intervention.