Saudi Journal of Gastroenterology
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Year : 2012  |  Volume : 18  |  Issue : 1  |  Page : 71-72
Sudden onset epigastric pain and vomiting


Department of Surgery, University College of Medical Sciences, Delhi, India

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Date of Web Publication12-Jan-2012
 

How to cite this article:
Saha S, Jha A, Gupta S. Sudden onset epigastric pain and vomiting. Saudi J Gastroenterol 2012;18:71-2

How to cite this URL:
Saha S, Jha A, Gupta S. Sudden onset epigastric pain and vomiting. Saudi J Gastroenterol [serial online] 2012 [cited 2019 Dec 12];18:71-2. Available from: http://www.saudijgastro.com/text.asp?2012/18/1/71/91727


An 18-year-old male presented with complaints of sudden onset pain in epigastrium and left-sided lower chest followed by nausea and vomiting. Attempts to drink caused retching within 5 to 10 minutes. There was no history of trauma. Patient had a pulse rate of 100/min, blood pressure of 116/76 mmHg and respiratory rate of 22/min. Chest examination revealed markedly decreased air entry on left side. Patient had upper abdominal distension and tenderness. There was no guarding, rebound tenderness or organomegaly. Patient chest X-ray [Figure 1] and Barium study [Figure 2] was done.
Figure 1: Chest X-ray

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Figure 2: Barium study

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   Question Top


Q1. What is the diagnosis?


   Answer Top


Diaphragmatic hernia with herniation of stomach into left thorax and mesentroaxial volvulus. Chest X-ray [Figure 1] shows air fluid level in left hemithorax, collapsed lung and mediastinal shift to right. Barium study [Figure 2] shows herniation of stomach into left thorax and mesentroaxial volvulus. Short arrow shows the gastro-esophageal junction and the long arrow indicates the pyloro-duodenal junction. Patient underwent emergency exploration by thoraco-abdominal incision. Stomach was found to be viable and it was reduced in the abdominal cavity and the repair of diagphragmatic defect with anterior gastropexy was done. Patient had uneventful postoperative recovery.

Borchardt's triad of vomiting, epigastric pain and inability to pass a nasogastric tube should warn clinician to consider a diagnosis of acute gastric volvulus. [1] In gastric volvulus, the etiology of rotation is either primary or secondary. Primary gastric volvulus is mainly idiopathic. Laxity of the ligaments which anchors the stomach in its normal position is a common cause of primary gastric volvulus. Secondary gastric volvulus occurs mainly in the presence of diaphragmatic defects such as: Congenital or traumatic diaphragmatic hernias, hiatal hernia, diaphragmatic eventrations. [2]

Anatomically, gastric volvulus can be classified into three types as proposed by Singleton: [3] Organoaxial, mesentroaxial and combined-unclassified. In organoaxial, the stomach rotates around longitudinal axis with the greater curvature rotating most often anteriorly. In mesentroaxial volvulus, rotation occurs around the transgastric line-a-line connecting the middle of lesser curvature with middle of the greater curvature. The treatment is surgical; consisting of laparotomy, derotation of stomach, anterior gastropexy and repair of diaphragmatic hernia.

 
   References Top

1.Chau B, Dufel S. Gastric volvulus. Emerg Med J 2007;74:446-7.  Back to cited text no. 1
    
2.Carter R, Brewer LA 3 rd , Hinshaw DB. Acute gastric volvulus: A study of 25 cases. Am J Surg 1980;140:99-106.  Back to cited text no. 2
    
3.Singleton AC. Chronic gastric volvulus. Radiology 1940;34:53-61.  Back to cited text no. 3
    

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Correspondence Address:
Sudipta Saha
C56Z4, Dilshad Garden, Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1319-3767.91727

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