Acute gastric volvulus: a deadly but commonly forgotten complication of hiatal hernia

Authors

  • Kailee Imperatore Mount Sinai Medical Center, Miami Beach/FL. Department of Pathology
  • Brandon Olivieri Mount Sinai Medical Center, Miami Beach/FL. Department of Radiology
  • Cristina Vincentelli Mount Sinai Medical Center, Miami Beach/FL. Department of Pathology - Florida International University, Miami/FL. Herbert Wertheim College of Medicine

DOI:

https://doi.org/10.4322/acr.2016.024

Keywords:

Stomach Volvulus, Hernia, Hiatal, Autopsy

Abstract

Gastric volvulus is a rare condition resulting from rotation of the stomach beyond 180 degrees. It is a difficult condition to diagnose, mostly because it is rarely considered. Furthermore, the imaging findings are often subtle resulting in many cases being diagnosed at the time of surgery or, as in our case, at autopsy. We present the case of a 76-year-old man with an extensive medical history, including coronary artery disease with multiple bypass grafts, who became diaphoretic and nauseated while eating. His presumptive diagnosis at arrival to the hospital was an acute coronary event; however, his initial cardiac work-up was negative. A computed tomography scan revealed a type III hiatal hernia. The following day, after consistent complaints of nausea and episodes of nonbloody emesis, he suddenly became hypotensive, tachycardic and had an episode of coffee-ground emesis. Subsequently, the patient’s condition suddenly deteriorated and resuscitation attempts were unsuccessful. The autopsy revealed a partially sliding hiatal hernia, which was consistent with the radiologic impression. Additionally, a gastric volvulus was present with extensive, focally transmural necrosis involving the body/fundus. Gastric volvulus is a rare entity with variable, nonspecific clinical presentations, which requires a high level of suspicion for radiologic diagnosis. Acute cases have a high mortality rate and require emergency surgery. This case highlights the value of autopsy in the diagnosis of unsuspected cases of gastric volvulus when death occurs prior to surgical intervention

Downloads

Download data is not yet available.

Downloads

Published

2016-03-10

How to Cite

Imperatore, K., Olivieri, B., & Vincentelli, C. (2016). Acute gastric volvulus: a deadly but commonly forgotten complication of hiatal hernia. Autopsy and Case Reports, 6(1), 21-26. https://doi.org/10.4322/acr.2016.024

Issue

Section

Article / Autopsy Case Report