51 years old women presenting with abdominal pain

 

Images

Doctor's Information

Name : Hamidreza
Family : Haghighatkhah
Affiliation :Radiology department,ShohadaTajrish Hospital,SBMU
Academic Degree : Associate professor of Radiology
Email : This email address is being protected from spambots. You need JavaScript enabled to view it.
Resident : Elham Dehghan

 

Case Section

Abdominal Imaging

 

Patient's Information

Gender : Female
Age : 51

 

Clinical Summary

51 years old women presenting with abdominal pain with history of spelenctomy and left nephrectomy because of trauma 5 years ago

 

Imaging Findings

Images show gastric herneiation from left hemidiaphragmatic defect with non perforated mesenteroaxial volvulus.

 

Differential Diagnosis

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Final Diagnosis

mesenteroaxial gastric volvulus

 

Discussion (Related Text)

The stomach is a relatively uncommon site of volvulus. Patients with acute gastric volvulus typically present with epigastric pain, nausea, and vomiting. Gastric volvulus is usually divided into two main subtypes: organoaxial and mesenteroaxial. Organoaxial volvulus is far more common than mesenteroaxial volvulus and accounts for approximately two-thirds of cases of gastric volvulus. Both are surgical emergencies and warrant prompt diagnosis and treatment. Organoaxial volvulus occurs when the stomach rotates along its long axis and becomes obstructed, with the greater curvature being displaced superiorly and the lesser curvature located more caudally in the abdomen The antrum rotates anterosuperiorly, and the fundus rotates posteroinferiorly. In adults, organoaxial volvulus most commonly occurs in the setting of a post-traumatic or paraesophageal hernia. Mesenteroaxial volvulus is much less common than organoaxial volvulus. It occurs when the stomach rotates along its short axis, with resultant displacement of the antrum above the gastroesophageal junction some patients may have a complex gastric volvulus, with both organoaxial and mesenteroaxial components. Radiographic findings of gastric volvulus include herniation of a large portion of the stomach above the diaphragm, often with differential air-fluid levels . An upper gastrointestinal (GI) series may be performed to evaluate the rotation of the stomach, as well as to detect passage of ingested oral contrast material into the duodenum. Multi–detector row CT often is performed in the setting of epigastric pain and vomiting and can help confirm the rotation of the herniated stomach and the transition point .

 

References

hllttp://radiographics.highwire.org/content/29/5/1281.full

 

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