An Example of Cascade Stomach

CASE REPORT A 68-year-old woman with a history of appendectomy, hysterectomy, and bilateral inguinal hernia repairs presented with 1.5 years of intermittent dyspepsia and vomiting without change in bowel pattern. Laboratory testing, magnetic resonance elastography, and colonoscopy were largely unremarkable. Esophagogastroduodenoscopy revealed mild reflux esophagitis and a J-shaped stomach with a submucosal band demarcation between the body and fundus (Figure 1). Subsequent X-ray upper gastrointestinal series confirmed the diagnosis of cascade stomach by showing contrast pooling within a posteriorly oriented proximal stomach that had minimal flow while standing supine unless the patient underwent torso flexion (Figure 2). Cascade, or “Cup-and-spill,” stomach is a unique anatomical variant in which the fundus of the stomach is folded dorsally over the body resulting in a pooling of ingested material in the fundus before eventually “cascading” into the body.1,2 Associated upper gastrointestinal symptoms are common, and while there is no current treatment guideline, conservative management is often tried before surgical correction.2–5 This patient was prescribed a proton pump inhibitor and advised to engage in postprandial forward fold stretching and to avoid lying supine for several hours after meals. On follow-up 4 months later, she reported an improvement in her symptoms.Figure 1.: (A) Retroflexed image from esophagogastroduodenoscopy with yellow arrows highlighting demarcation between gastric body and fundus. (B) Image from esophagogastroduodenoscopy with yellow arrows highlighting demarcation between gastric body and fundus.Figure 2.: (A) Image from X-ray upper gastrointestinal series showing contrast pooling in gastric fundus. (B) Image from X-ray upper gastrointestinal series showing forward flow of contrast from gastric fundus to body with torso flexion.DISCLOSURES Author contributions: All authors significantly contributed to the writing of this manuscript. Justin Howard is the article guarantor. Financial disclosure: None to report. Informed consent was obtained for this case report.