Endoscopic Reduction of an Acute Gastric Volvulus Followed By Delayed Laparoscopic Repair

Ihab O Elhassan, MD, Richard Lin, MD, Adam S Rosenstock, MD, Stephen Pereira

Hackensack University Medical Center

Gastric volvulus involves an abnormal rotation of the stomach resulting in gastric oultlet obstruction and an increased risk of gastric strangulation. It is most commonly associated with paraesophageal hernias and carries mortality rates as high as 30-50%. As a result, quick recognition and prompt surgical correction has been the key aspects of management. We report a case of acute gastric volvulus in which an emergent endoscopy was able to detorse the stomach and enabled surgery to be performed 72hours later.

Our patient is a 75yo female who presented to the ER with complaints of sudden onset abdominal and chest pain associated with nausea and unproductive retching. Two attempts to place a nasogastric tube at the bedside failed. A CT scan showed a large distended stomach located mostly in the left chest confirming the diagnosis of an mesenteroaxial gastric volvulus. The gastroenterologist performed a bedside EGD with successful reduction of the volvulus and passage of the scope past the pylorus. An NGT was then placed endoscopically. This enabled the treating team to adequately resuscitate the patient and perform the surgical repair in a less emergent fashion. The patient subsequently underwent successful laparoscopic repair 72 hours after presentation.

In the absence of signs and findings suggesting tissue ischemia, endoscopic reduction of acute gastric volvulus is a feasible substitute to emergent surgical repair. It can provide the treating team more time for resuscitation and medical optimization.

Session: Poster Presentation

Program Number: P248

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