What's the Diagnosis? By Dr. Katie Selman

A 90 yo male admitted to the hospital 4 days ago begins having nausea and vomiting. Emesis is dark brown in color and continues despite anti-emetics. On exam, his abdomen is soft, mildy distended, and nontender. You obtain a stat portable abdominal x-ray. What's the diagnosis?  (scroll down for answer) 





Answer: Gastric volvulus

  • Volvulus: twisting of intestine around its mesenteric attachment causing a bowel obstruction and potential ischemia
  • Most common form is sigmoid volvulus (elderly patients, history of constipation, anticholingeric meds) 
    • Associated with "coffee bean sign" on x-ray
  • Cecal volvulus (seen in younger patients, pregnancy, marathon runners)
  • Gastric volvulus is a rare form in which the stomatch twists 180 degrees
    • Surgical emergency
    • Borchadt's Triad: vomiting + epigastric pain + inability to pass NG tube
    • Risk factors: pediatric patients with congential diaphragmatic defects, elderly patients, gastric tumors, diaphragmatic injury, hiatal hernia, L lung resection, pleural adhesions
    • Definitive diagnosis: barium upper GI series vs CT scan



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Kiyani A, Khosla M, Anufreichik V, Chuang K-Y. “A Large Hiatal Hernia”: Atypical Presentation of Gastric Volvulus. Clinical Practice and Cases in Emergency Medicine. 2017;1(3):187-189. 

Jabbour G, Afifi I, Ellabib M, El-Menyar A, Al-Thani H. Spontaneous Acute Mesenteroaxial Gastric Volvulus Diagnosed by Computed Tomography Scan in a Young Man. The American Journal of Case Reports. 2016;17:283-288.