Interesting and unusual cases of chronic abdominal pain-intermittent gastric volvulus

Abstract

Objective: Intermittent gastric volvulus is a rare disease that requires high index of suspicion for diagnosis and treatment. The incidence and prevalence is unknown, may be due to under reporting or under diagnosis. Gastric volvulus may be transient producing few symptoms. The Borchardt’s Triad may be present only during an acute presentation. Common symptoms may mislead to diagnose a nonsurgical disease if an evaluation is not done, keeping in mind a possibility of gastric volvulus, even if a UGI scopy is normal. Cases may be submerged in the community being undiagnosed. Case Series: CASE 1: 21 yrs old male with intermittent abdominal pain for 1(1/2) yrs with marfanoid habitus, MVP and a normal UGI scopy. BMS revealed an Organo-Axial Volvulus and ligament laxity per-operatively. CASE 2: 65 yrs old diabetic female with vomiting and abdominal pain for 3 months and left sided pneumonitis. UGI scopy showed twisted gastric folds immediately below OGJ and inability to visualise antrum. BMS revealed mixed volvulus with paraesophageal herniation of distal stomach. Per-operatively there was laxity of ligaments with omental content alone within the diaphragmatic rent. Posterior retrocolic sub-mucosal gastrojejunostomy(pexy) was done for all cases. Conclusion: Gastric volvulus should be thought of in a case of chronic intermittent abdominal pain with normal baseline evaluation. A Chest X-ray and BMS should be done, at the time of symptoms.