Gastric Volvulus: A Rare Diagnosis Of Abdominal Pain

Abstract

Gastric volvulus (GV) is a rare but life-threatening condition in case of delay in diagnosis and treatment. Herein, we presented a case of GV due to Morgagni hernia presenting to the emergency department with complaints of abdominal pain and distention. A 59-year-old male patient was admitted to the emergency department with abdominal pain and distension, nausea and vomiting. His past medical history included coronary artery disease, hypertension, multiple sclerosis and left diaphragmatic hernia. On initial examination, pulse rate was 119/min and other vital signs were normal. Abdominal examination revealed epigastric tenderness. Posteroanterior chest X-ray showed an air bubble in the left hemithorax. Thoracoabdominal CT was performed for differential diagnosis. Department of Emergency Radiology reported a mesenteroaxial gastric volvulus at the superior gastro-esophageal junction with a Morgagni hernia including left hemidiaphragmatic defect with herniation of the gastric corpus, first part of the duodenum and transverse colon. Following placement of the nasogastric tube, 1300 mL gastric secretion was drained and abdominal distention was relieved. Patient was referred to the operating room. Morgagni hernia and the diaphragm defect were repaired. During follow-up in general surgery ward, a sudden cardiac arrest developed on the 5th day and he died. If a patient presents to the emergency departmen with abdominal pain and distention, GV should be considered in the differential diagnosis, although rare.