A Rare Twist: Case Study on Gastrohepatic Volvulus
Source: PubMed Central Open Access, NCBI / U.S. National Library of Medicine
A gastric volvulus occurs when the stomach rotates around itself, creating a closed-loop obstruction. This can result in a life-threatening condition in which supporting vasculature can be obstructed and lead to ischemia, necrosis, and perforation. A gastrohepatic volvulus is an exceedingly rare type of gastric volvulus in which the stomach rotates in relation to the liver, specifically around the gastrohepatic ligament. We present a case of a 39-year-old female with a history of congenital malrotation and developmental delay who presented to the emergency room for nausea and emesis. Physical examination revealed a distended and tense abdomen. A CT scan was completed, revealing abnormal positioning of a distended stomach located in the right upper quadrant and the liver located in the left upper quadrant. An emergent exploratory laparotomy revealed complete gastrohepatic volvulus. The stomach and liver were both found to have visible signs of ischemia with dusky discoloration of both organs. After manual detorsion, adequate blood flow was re-established, as evidenced by the return of normal coloration. Gastrohepatic volvulus represents an exceedingly rare and previously unreported variant of gastric volvulus. This case highlights the potential for atypical anatomical presentations to mimic other conditions, such as heterotaxy syndrome. It underscores the critical importance of maintaining a high index of suspicion in patients with acute abdominal symptoms and abnormal imaging
Abstract
A gastric volvulus occurs when the stomach rotates around itself, creating a closed-loop obstruction. This can result in a life-threatening condition in which supporting vasculature can be obstructed and lead to ischemia, necrosis, and perforation. A gastrohepatic volvulus is an exceedingly rare type of gastric volvulus in which the stomach rotates in relation to the liver, specifically around the gastrohepatic ligament. We present a case of a 39-year-old female with a history of congenital malrotation and developmental delay who presented to the emergency room for nausea and emesis. Physical examination revealed a distended and tense abdomen. A CT scan was completed, revealing abnormal positioning of a distended stomach located in the right upper quadrant and the liver located in the left upper quadrant. An emergent exploratory laparotomy revealed complete gastrohepatic volvulus. The stomach and liver were both found to have visible signs of ischemia with dusky discoloration of both organs. After manual detorsion, adequate blood flow was re-established, as evidenced by the return of normal coloration. Gastrohepatic volvulus represents an exceedingly rare and previously unreported variant of gastric volvulus. This case highlights the potential for atypical anatomical presentations to mimic other conditions, such as heterotaxy syndrome. It underscores the critical importance of maintaining a high index of suspicion in patients with acute abdominal symptoms and abnormal imaging findings. Prompt recognition, a multidisciplinary approach, and emergent surgical intervention are essential to prevent irreversible ischemic injury and associated complications.