Acute right intrathoracic gastric volvulus. A rare surgical emergency

Abstract

The acute intrathoracic gastric volvulus is a rare condition, difficult to diagnose and treat. It consist in a abnormal organo-axial rotation over 180°, associated with gastric obstruction or strangulation. More uncommon condition is the gastric volvulus caused by a right sliding diaphragmatic hernia and dislocating the stomach, or part of it, on the right hemithorax. Gastric volvulus classic clinical presentation described by Borchardt, consist on a triad of severe epigastric pain, vomiting followed by retching without ability to vomit and difficulty or inability to pass a nasogastric tube.

Imaging, beginning from a simple chest radiograph showing an elevated gastric air-fluid level in lower lung segments, can help to define diagnosis and to determine the immediate necessity to operate trying to avoid fatal complications as gastric ischemia, perforation or haemorrhage. We present the case of a 58 year-old man arrived at our Emergency Department with moderate acute epigastric pain and already vomiting from 4 hours. The patient underwent initially a chest radiograph, Computed Tomography, upper digestive endoscopy, upper digestive contrasted radiology and then was operated. Post operative situation of the patient on recovery and during the 3 months follow up didn’t experience any pain or difficulty in feeding.