Acute Mesenteroaxial Gastric Volvulus Complicated by Splenic Injury Requiring Splenectomy

Gastric volvulus is a rare but potentially life-threatening surgical emergency associated with significant morbidity and mortality when diagnosis and treatment are delayed.Although complications such as gastric ischemia and perforation are well recognized, splenic injury secondary to gastric volvulus is exceedingly rare.We present the case of a 60-year-old woman who presented with acute epigastric pain, nausea, and vomiting following a meal.Computed tomography demonstrated a mesenteroaxial gastric volvulus.Initial nasogastric tube decompression resulted in symptomatic improvement; however, repeat imaging demonstrated persistent volvulus with increasing free fluid, prompting exploratory laparotomy.Intraoperatively, hemoperitoneum was identified and attributed to splenic capsular tears caused by traction on the gastrosplenic ligament from the distended, volvulized stomach.The patient underwent detorsion of the volvulus, gastropexy, and splenectomy, followed by an uncomplicated recovery in the surgical intensive care unit.This case highlights the importance of maintaining a high index of suspicion for splenic injury in the setting of gastric volvulus and underscores the need for timely surgical intervention when conservative management fails.