Acute Gastric Volvulus in the Elderly: A Diagnostic and Surgical Challenge

Introduction: Acute gastric volvulus is a rare but critical surgical emergency characterized by the abnormal rotation of the stomach by at least 180°, often secondary to a hiatal hernia. Due to the atypical presentation of symptoms, diagnosis can be challenging. This case study highlights the importance of imaging in diagnosing gastric volvulus and the effective management strategies employed. Clinical case: We present a case of an 85-year-old female with a history of type 2 diabetes, arterial hypertension, coronary artery disease, and a pacemaker, who presented with acute epigastric pain, nausea, vomiting, distention, and constipation. The diagnosis was confirmed using computed tomography (CT), which revealed a left diaphragmatic hernia and stomach volvulus. Surgical exploration via a median supra-umbilical incision confirmed organoaxial volvulus secondary to a Bochdalek hernia. Treatment involved derotation of the stomach, repair of the diaphragmatic defect, and placement of a drain. The patient recovered uneventfully and was discharged on postoperative day 10. Discussion: Gastric volvulus presents with atypical symptoms and can be classified as organoaxial or mesoaxial. Key radiological findings, including the “caterpillar sign” on X-rays and rotation of the stomach on CT scans, are crucial for diagnosis. Treatment typically includes stabilization, surgical derotation, and gastropexy, with laparoscopic surgery offering benefits of reduced recovery time and less postoperative pain. Careful postoperative monitoring is essential to identify complications such as perforations and to manage recurrence. Conclusion: Gastric volvulus, while rare, requires prompt diagnosis and intervention. Radiological imaging is essential for accurate diagnosis and effective surgical management. Despite advancements in treatment, the risk of recurrence necessitates continued research to refine treatment approaches and improve patient outcomes. Keywords: Acute GastricVolvulus, old woman, Bochdalek hernia, Organoaxial Volvulus, Computed Tomography (CT), surgery.