Acute gastric outlet obstruction after left hemicolectomy

Division of Gastroenterology, China Medical University Hospital, China Medical University, Taichung, Taiwan.
Gastroenterology (Impact Factor: 16.72). 09/2012; 143(5):e12-3. DOI: 10.1053/j.gastro.2012.04.002
Source: PubMed
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    ABSTRACT: The authors describe a case of gastric volvulus, which is a rare cause of gastric outlet obstruction. An 85-year-old man presented with nausea, vomiting, and epigastric pain. Admission abdominal radiograph demonstrated a grossly distended stomach with air-fluid levels. Multiple attempts at nasogastric tube placement failed. Endoscopy revealed a fluid-filled, tortuous stomach with a paraesophageal hernia, and the operator was unable to locate or pass the scope through the pylorus. Traditionally Borchardt's triad is believed to be diagnostic for acute gastric volvulus and consists of unproductive retching, epigastric pain and distention, and the inability to pass a nasogastric tube. The authors propose that the following features on endoscopy are highly suggestive of the most common type of volvulus (organoaxial): tortuous stomach, paraesophageal hernia, and inability to locate or pass the scope through the pylorus.
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    ABSTRACT: Volvulus of sigmoid colon and cecum is not uncommon in tropical Africa, but gastric volvulus is relatively rare, especially when compared with various causes of peptic ulcer syndrome seen at the University College Hospital in Ibadan, Nigeria.A case of chronic intermittent type of gastric volvulus with superficial gastric ulcerations was recently seen and treated by vagotomy, pyloroplasty, and gastropexy.Predisposing factors, various types, presentations, and management of gastric volvulus are discussed.Since an acute attack of gastric volvulus, which is rare and possibly fatal if not adequately treated, can be confused with gastric outlet obstruction resulting from chronic duodenal ulcer, which is common, an index of suspicion is essential for the diagnosis of gastric volvulus.
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