AJM onlineDiagnostic dilemmaIntermittent Gastric Volvulus Mimicking Acute Coronary Syndrome
Section snippets
Presentation
Intermittent gastric volvulus plagued a 61-year-old white woman with chest pain for months before it was observed on esophagogastroduodenoscopy (EGD). She presented to the Emergency Department with complaints of progressively worsening localized, burning, left-sided and substernal chest pain that was identical to her previous myocardial infarction. Her chest pain was associated with nausea, vomiting, and shortness of breath. She experienced no relief with the administration of sublingual
Assessment
Upon admission, her vital signs were entirely within normal limits and she appeared to be resting comfortably with no evidence of distress. Apart from vague epigastric tenderness, she exhibited no abnormalities on physical examination. Her complete blood count was within normal limits and her comprehensive metabolic profile was unremarkable apart from her creatinine of 1.38 mg/dL, which was near her baseline. She had a lipase of 59 U/L. Her D-dimer and troponin I were both unremarkable, with
Diagnosis
With a negative cardiac work-up and recent unremarkable left heart catheterization, the patient underwent an EGD that showed a large paraesophageal hernia and gastric volvulus. The patient then underwent imaging via upper gastrointestinal series with small bowel follow-through that showed the stomach in an organoaxial position without evidence of gastric volvulus and with normal transit of contrast into the small bowel. The intermittent nature of her gastric volvulus was confirmed via its
Management
Gastric volvulus is a rare condition with peak incidence after approximately age 50 years, with adults comprising > 80% of cases.1 Gastric volvulus may present as organoaxial, mesenteroaxial, or combined varieties. Approximately 60% of gastric volvulus cases encountered are of the organoaxial variety and are associated with diaphragmatic hernias, paraesophageal hernias, and diaphragmatic eventration.2, 3 Gastric volvulus occurs when the stomach rotates upon its horizontal or vertical axis,
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Cited by (3)
Successful outcome in acute gastric volvulus in a low resource hospital setting in Bangladesh: A case report
2020, International Journal of Surgery Case ReportsCitation Excerpt :Standard surgical approach involves emergency laparotomy with anterior gastropexy (fixation of the stomach to the anterior abdominal wall); however, partial or total gastrectomy may be required in cases of gastric necrosis or perforation [11]. In high-risk patients who are poor surgical candidates, endoscopic decompression and reduction can be considered [21]. Conservative management includes endoscopic reduction or percutaneous endoscopic gastrotomy tube insertion and is recommended in chronic cases, especially in the elderly [7].
Chronic gastric volvulus—Case report of an uncommon diagnosis
2020, International Journal of Surgery Case ReportsCitation Excerpt :The gastric volvulus are classified according to the axis in which the rotation occurs. It can be organo-axial [1–9], mesentero-axial [1–9] or mixed/combined [2,5,8,9]. The organo-axial volvulus occurs when there is a rotation upon the longitudinal axis of the stomach, that is the line between the cardia and the pylorus.
Gastric volvulus presenting as an acute coronary syndrome with long-lasting electrocardiographic changes
2019, Journal of Geriatric Cardiology
Funding: None.
Conflict of Interest: The authors have no conflicts of interest to disclose.
Authorship: All authors had access to the data and an active role in writing the manuscript.