Acute gastric volvulus associated with wandering spleen in an adult treated laparoscopically after endoscopic reduction: a case report View Full Text


Ontology type: schema:ScholarlyArticle      Open Access: True


Article Info

DATE

2016-05-24

AUTHORS

Jiro Omata, Katsuyuki Utsunomiya, Yoshiki Kajiwara, Risa Takahata, Nobuo Miyasaka, Hidekazu Sugasawa, Naoko Sakamoto, Yoji Yamagishi, Makiko Fukumura, Daiki Kitagawa, Mitsuhiko Konno, Yasushi Okusa, Michinori Murayama

ABSTRACT

A 43-year-old female was referred to our hospital for sudden onset of abdominal pain, fullness, and vomiting. Physical examination revealed abdominal distension with mild epigastric tenderness. Abdominal radiography showed massive gastric distension and plain computed tomography (CT) a markedly enlarged stomach filled with gas and fluid. A large volume of gastric contents was suctioned out via a nasogastric (NG) tube. Contrast-enhanced CT showed a grossly distended stomach with displacement of the antrum above the gastroesophageal junction, and the spleen was dislocated inferiorly. Upper gastrointestinal (GI) series showed the greater curvature to be elevated and the gastric fundus to be lower than normal. Acute mesenteroaxial gastric volvulus was diagnosed. GI endoscopy showed a distortion of the gastric anatomy with difficulty intubating the pylorus. Various endoscopic maneuvers were required to reposition the stomach, and the symptoms showed immediate and complete solution. GI fluoroscopy was performed 3 days later. Initially, most of the contrast medium accumulated in the fundus, which was drawn prominently downward, and then began flowing into the duodenum with anteflexion. Elective laparoscopic surgery was performed 1 month later. The stomach was in its normal position, but the fundus was folded posteroinferiorly. The spleen attached to the fundus was normal in size but extremely mobile. We diagnosed a wandering spleen based on the operative findings. Gastropexy was performed for the treatment of gastric volvulus and wandering spleen. The patient remained asymptomatic, and there was no evidence of recurrence during a follow-up period of 24 months. This report describes a rare adult case of acute gastric volvulus associated with wandering spleen. Because delay in treatment can result in lethal complications, it is critical to provide a prompt and correct diagnosis and surgical intervention. We advocate laparoscopic surgery after endoscopic reduction because it is a safe and effective procedure with lower invasiveness. More... »

PAGES

47

Identifiers

URI

http://scigraph.springernature.com/pub.10.1186/s40792-016-0175-0

DOI

http://dx.doi.org/10.1186/s40792-016-0175-0

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1032801347

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/27221130


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16 schema:description A 43-year-old female was referred to our hospital for sudden onset of abdominal pain, fullness, and vomiting. Physical examination revealed abdominal distension with mild epigastric tenderness. Abdominal radiography showed massive gastric distension and plain computed tomography (CT) a markedly enlarged stomach filled with gas and fluid. A large volume of gastric contents was suctioned out via a nasogastric (NG) tube. Contrast-enhanced CT showed a grossly distended stomach with displacement of the antrum above the gastroesophageal junction, and the spleen was dislocated inferiorly. Upper gastrointestinal (GI) series showed the greater curvature to be elevated and the gastric fundus to be lower than normal. Acute mesenteroaxial gastric volvulus was diagnosed. GI endoscopy showed a distortion of the gastric anatomy with difficulty intubating the pylorus. Various endoscopic maneuvers were required to reposition the stomach, and the symptoms showed immediate and complete solution. GI fluoroscopy was performed 3 days later. Initially, most of the contrast medium accumulated in the fundus, which was drawn prominently downward, and then began flowing into the duodenum with anteflexion. Elective laparoscopic surgery was performed 1 month later. The stomach was in its normal position, but the fundus was folded posteroinferiorly. The spleen attached to the fundus was normal in size but extremely mobile. We diagnosed a wandering spleen based on the operative findings. Gastropexy was performed for the treatment of gastric volvulus and wandering spleen. The patient remained asymptomatic, and there was no evidence of recurrence during a follow-up period of 24 months. This report describes a rare adult case of acute gastric volvulus associated with wandering spleen. Because delay in treatment can result in lethal complications, it is critical to provide a prompt and correct diagnosis and surgical intervention. We advocate laparoscopic surgery after endoscopic reduction because it is a safe and effective procedure with lower invasiveness.
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22 schema:keywords GI endoscopy
23 abdominal distension
24 abdominal pain
25 abdominal radiography
26 acute gastric volvulus
27 acute mesenteroaxial gastric volvulus
28 adult cases
29 adults
30 anatomy
31 anteflexion
32 antrum
33 case report
34 cases
35 complete solution
36 complications
37 computed tomography
38 content
39 contrast medium
40 contrast-enhanced computed tomography
41 correct diagnosis
42 curvature
43 days
44 delay
45 diagnosis
46 difficulties
47 displacement
48 distension
49 distortion
50 duodenum
51 effective procedure
52 elective laparoscopic surgery
53 endoscopic maneuvers
54 endoscopic reduction
55 endoscopy
56 epigastric tenderness
57 evidence
58 evidence of recurrence
59 examination
60 females
61 findings
62 fluid
63 fluoroscopy
64 fullness
65 fundus
66 gas
67 gastric anatomy
68 gastric contents
69 gastric distension
70 gastric fundus
71 gastric volvulus
72 gastroesophageal junction
73 gastrointestinal series
74 gastropexy
75 greater curvature
76 hospital
77 intervention
78 invasiveness
79 junction
80 laparoscopic surgery
81 large volumes
82 lethal complication
83 low invasiveness
84 maneuvers
85 massive gastric distension
86 medium
87 mesenteroaxial gastric volvulus
88 mild epigastric tenderness
89 months
90 nasogastric tube
91 normal position
92 onset
93 operative findings
94 pain
95 patients
96 period
97 physical examination
98 plain computed tomography
99 position
100 procedure
101 pylori
102 radiography
103 rare adult case
104 recurrence
105 reduction
106 report
107 series
108 size
109 solution
110 spleen
111 stomach
112 sudden onset
113 surgery
114 surgical intervention
115 symptoms
116 tenderness
117 tomography
118 treatment
119 tube
120 upper gastrointestinal series
121 volume
122 volvulus
123 vomiting
124 schema:name Acute gastric volvulus associated with wandering spleen in an adult treated laparoscopically after endoscopic reduction: a case report
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