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• W2920913922 abstract "Gastric volvulus is characterized by rotation of the stomach along its long or short axis leading to variable degrees of gastric outlet obstruction, which may present acutely or chronically. It can be primary (due to gastric ligaments) or secondary (due to anatomical abnormalities). Organoaxial volvulus is the most common type of abnormal rotation, occurring in 60 percent of cases of gastric volvulus, and is associated with secondary etiologies. Here we present a case of chronic postprandial nausea and epigastric pressure secondary to J shaped stomach and past history of surgery causing gastric organoaxial volvulus. A 70-year-old F with a history of Crohn's disease complicated by perianal fistula, required total colectomy with end ileostomy for medically refractory disease, She, presents with 1 year of sudden onset postprandial nausea and pressure in the epigastric area with bloating and occasional vomiting, that would as quickly resolve. Of note, she has history of adhesive bowel obstruction and PUD for which she was treated with PPI. On physical exam including stool ileostomy appliance was unremarkable. Her symptoms were believed be due to recurrence of PUD and she was restarted on rabeprazole. However, EGD did not show any active ulcer (EGD image A). Further work up with CT enterography revealed that patient had J -shaped stomach and narrowing of duodenum in D3 (image B). Push enteroscopy was done which revealed collapsed and rotated pyloric channel that was quite difficult to intubate suggestive of gastric organoaxial volvulus at the time of the endoscopy. The patient was at high risk for this complication given her baseline J shaped stomach and her surgical history which limited the tethering effect of the colon.Patient was referred for surgical evaluation but she preferred to manage her complaints nonoperatively. Patients with chronic or intermittent gastric volvulus have vague and often subclinical presentations. Chronic symptoms include mild upper abdominal discomfort, dysphagia, bloating, and heartburn and acute symptoms can be related to presentation of gastric outlet obstruction. Our patient was at high risk of volvulus due to abnormal J shaped stomach and no colon. This case highlights the importance of multimodal intervention to diagnose rare cause of chronic nausea and abdominal pain.2643_A Figure 1. Mild gastritis2643_B Figure 2. Showing J shaped stomach and narrowing of duodenum in D3 causing organo-axial volvulus" @default.
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• W2920913922 date "2018-10-01" @default.
• W2920913922 modified "2023-09-26" @default.
• W2920913922 title "Chronic Gastric Volvulus - A Rare Cause of Nausea and Epigastric Pain" @default.
• W2920913922 doi "https://doi.org/10.14309/00000434-201810001-02642" @default.
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