Impending gastric volvulus with multifactorial etiology – A case report

Gastric volvulus is a rare diagnosis, often missed, but fatal in the setting of gastric ischemia. People with a surgical abdomen or with anatomic disturbances are at higher risk and should be evaluated when nausea and vomiting go unexplained. People might get labelled with functional disorders, preventing further investigation. Lastly, if and when diagnosed, aggressive management, including surgical management, should be undertaken. In our case the patient presented with recurrent nausea and vomiting. She had been treated for reflux disease in the past with fundoplication and had been treated for cyclic vomiting, gastroparesis without much relief. Endoscopies were unremarkable till a study done during an active episode demonstrated volvulus. This highlights the importance of high suspicion amongst surgical cases since the endoscopic studies are non-revealing outside of the episode. Endoscopy also holds therapeutic value with detorsion techniques. Surgical fixation is considered the definitive treatment to avoid potential complications, including bowel ischemia/necrosis and death. The patient finally underwent anterior gastropexy with symptom resolution. • Patient Profile: A 61-year-old female with a history of GERD, hiatal hernia, and prior fundoplication presented with recurrent episodes of nausea, vomiting, and epigastric pain. Luminal twisting consistent with gastric volvulus was only visualized during endoscopy performed amid an acute symptomatic episode. • Diagnostic Challenge : Despite multiple imaging and endoscopic studies, initial investigations were unremarkable. It indicated the transient nature of the episodes and hence the radiological and endoscopic findings. Symptoms were misattributed to gastroparesis, one of the complications of the surgery. • Risk Factors: Fundoplication, use of Botox, and prucalopride formed risk factors for underlying volvulus. • Management : Endoscopic detorsion was performed, followed by surgical anterior gastropexy, resulting in complete symptom resolution at 6-month follow-up.