What's the Diagnosis? By Dr. Katie Selman
A 90 yo male admitted to the hospital 4 days ago begins having nausea and vomiting. Emesis is dark brown in color and continues despite anti-emetics. On exam, his abdomen is soft, mildy distended, and nontender. You obtain a stat portable abdominal x-ray. What's the diagnosis? (scroll down for answer)
Answer: Gastric volvulus
- Volvulus: twisting of intestine around its mesenteric attachment causing a bowel obstruction and potential ischemia
- Most common form is sigmoid volvulus (elderly patients, history of constipation, anticholingeric meds)
- Associated with "coffee bean sign" on x-ray
- Cecal volvulus (seen in younger patients, pregnancy, marathon runners)
- Gastric volvulus is a rare form in which the stomatch twists 180 degrees
- Surgical emergency
- Borchadt's Triad: vomiting + epigastric pain + inability to pass NG tube
- Risk factors: pediatric patients with congential diaphragmatic defects, elderly patients, gastric tumors, diaphragmatic injury, hiatal hernia, L lung resection, pleural adhesions
- Definitive diagnosis: barium upper GI series vs CT scan
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Kiyani A, Khosla M, Anufreichik V, Chuang K-Y. “A Large Hiatal Hernia”: Atypical Presentation of Gastric Volvulus. Clinical Practice and Cases in Emergency Medicine. 2017;1(3):187-189.
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