Gastric volvulus

Kalaiselvi1, Subadhra Devi2, Maha Lakshmi3

1Senior Nursing Supervisor, Kauvery Hospital, Cantonment, Trichy, Tamil Nadu

2Nurse Educator Kauvery Hospital, Cantonment, Trichy, Tamil Nadu

3Nursing Superintendent, Kauvery Hospital, Cantonment, Trichy, Tamil Nadu

Abstract

Gastric volvulus is a rare surgical emergency that can present with acute upper abdominal symptoms and requires prompt diagnosis and treatment. We report a case of a patient presenting with a two-day history of worsening upper abdominal pain, nausea, vomiting, and abdominal distension, with preserved passage of flatus and stools. Computed tomography of the abdomen and pelvis showed gastric volvulus with eventration of the left hemidiaphragm, dilated splenic flexure, and displacement of the left kidney. The patient underwent emergency laparoscopic surgery, which confirmed an organoaxial gastric volvulus with a congested but viable stomach, along with a wandering spleen and diaphragmatic eventration. Laparoscopic gastric reduction and gastropexy were performed successfully. Early recognition and timely surgical intervention resulted in a favorable outcome and prevention of recurrence.

Introduction

Gastric volvulus is a rare medical condition in which the stomach twists abnormally around itself by more than 180°, leading to obstruction of food passage and potentially compromised blood flow to the stomach wall. This abnormal rotation can occur along different axes of the stomach — most commonly the long axis (organoaxial) or the short axis (mesenteroaxial) — and can present acutely with severe pain, vomiting, and inability to pass a nasogastric tube. Prompt diagnosis and treatment are critical to prevent serious complications like ischemia, necrosis, or perforation.

Image source: Annals of Laparoscopic and Endoscopic Surgery by Harry J. Wong

A 28yrs patient presented with a two-day history of progressively worsening upper abdominal pain, accompanied by persistent nausea and repeated episodes of vomiting. The patient also reported upper abdominal distension, although the ability to pass flatus and stools was preserved, suggesting partial rather than complete obstruction. There was no history of fever, trauma, previous abdominal surgery, or any known medical illness.

The patient was initially evaluated at an outside facility and subsequently referred for further assessment. On arrival, routine investigations were reviewed

Relevant Clinical Findings

  • Allergies: Not Know Medicine and Food Allergies
  • Past medical history: Nil
  • Past surgical history: Nil

Physical examination

Vitals signs

  • Temperature:99.9, HR:92/min, RR:20/min, BP :120/80 mmhg
  • Spo2-98% on Room Air
  • SPO2:98% on RA
  • P/A: Soft, Nontender, BS (+), Stomach fullness (+)
  • GRBS: 140mg/dl
  • Abdominal distended in the upper region.
  • Tenderness over epigastrium.

Relevant Investigation

On 17/6/2025

Test (PT)12.0 Seconds
INR1.05
Total Bilirubin0.99 mg/dL
Direct Bilirubin0.42 mg/dL
Alanine Aminotransferase (ALT/SGPT)17.8 U/L
Aspartate Aminotransferase (AST/SGOT)39.5 U/L
Indirect Bilirubin0.57 mg/dL
Amylase186 U/L
Lipase255 U/L
Gamma - Glutamyl Transferase (GGT)27 U/L

On 18/6/2025

Control (PT)11.4 Seconds
Alkaline Phosphatase48.8 U/L
Haemoglobin13.9 g/dl
Test (PT)12.6 Seconds
INR1.11
Lymphocyte6.3 %
Total WBC Count11250 Cells/Cumm
Control (PT)11.4 Seconds

CT abdomen and pelvis with contrast

Diagnosis

Gastric Volvulus

Management

Intraoperatively, an organoaxial gastric volvulus was confirmed, characterized by a large, redundant, and congested stomach, although the tissue remained viable. Additional findings included a wandering spleen located in the epigastrium anterior to the esophagogastric junction, significant eventration of the left hemidiaphragm, and abnormal displacement of the splenic flexure of the colon.

The surgical team performed laparoscopic gastric reduction followed by gastropexy to secure the stomach and prevent recurrence. The procedure was completed without complication, and the stomach was restored to its normal anatomical orientation.

Outcome

This patient’s gastric volvulus, associated with eventration of the left hemidiaphragm, was diagnosed early using CT imaging and managed successfully with emergency laparoscopic gastric reduction and gastropexy. Timely surgical intervention preserved gastric viability and prevented serious complications. Effective postoperative nursing care supported a smooth recovery, highlighting the importance of early diagnosis and prompt multidisciplinary management in gastric volvulus.

Discharge

Drug NameStrength
Tab. Pantocid 40MG
Tab. Paracetamol 1GM
Tab. Domstal 10MG
Tab. Tramadol 50MG

Medical and Surgical Aspects

The treatment included IV fluids along with several intravenous (IV) injections: Viatran 1.5 gm once daily, Metrogyl 500 mg three times a day, Pantocid 40 mg twice daily, Paracetamol 1 gm three times a day, Emeset 4 mg three times a day, and Tramadol 50 mg given as needed. Additionally, Clexane 40 mg was given subcutaneously (SC) once daily. The patient also received nebulization with Duolin + Budecort and underwent incentive spirometry as part of the management.

The patient underwent an emergency laparoscopic gastric reduction and gastropexy done under general anesthesia on 17.06.2025. The findings showed an organoaxial gastric volvulus with a large redundant stomach in the abdomen. The stomach was congested but viable, and the spleen was found in the epigastrium anterior to the oesophagogastric junction (OGJ). There was also eventration of the left hemidiaphragm with a wandering spleen and splenic flexure of colon lying up under the diaphragm in the chest. The procedure involved open access pneumoperitoneum where one 10 mm, one 12 mm optiport and three 5 mm ports were placed in the belly. The stomach was untwisted and brought to normal position in the left upper quadrant (LUQ) of the abdomen. The spleen fell back into normal position in LUQ. Gastric decompression was done through Ryle’s tube in the stomach. Gastropexy was performed with three‑point fixation using 2‑0 prolene suture – one at proximal greater curvature, one at mid greater curvature and one at distal body of the stomach in the belly. Haemostasis was checked in the operation site.

Skilled Nursing Care

  • Monitored vital signs regularly (blood pressure, pulse, respiratory rate, temperature, SpO₂).
  • Assessed abdominal pain, distension, bowel sounds, and signs of obstruction or ischemia.
  • Maintained strict intake and output charting; monitor urine output closely.
  • Administered intravenous fluids as prescribed to maintain hydration and electrolyte balance.
  • Provided nasogastric tube care (if in situ) and monitored gastric output.
  • Administered prescribed medications, including analgesics, antiemetics, antibiotics, and proton pump inhibitors.
  • Observed for postoperative complications such as bleeding, infection, gastric perforation, or recurrence of volvulus.
  • Performed regular wound assessment and maintained aseptic surgical site care.
  • Encouraged early ambulation to promote bowel motility and prevent deep vein thrombosis.
  • Supported respiratory function through deep breathing exercises and incentive spirometry.
  • Gradually advance diet as per medical orders, monitored tolerance and vomiting.
  • Provided patient education regarding diet modification, activity restrictions, wound care, and follow-up visits.
  • Ensured adequate pain relief while monitoring for side effects of medications.
  • Documented all assessments, interventions, and patient responses accurately.

Conclusion

This patient’s gastric volvulus, associated with eventration of the left hemidiaphragm, was diagnosed early using CT imaging and managed successfully with emergency laparoscopic gastric reduction and gastropexy. Timely surgical intervention preserved gastric viability and prevented serious complications. Effective postoperative nursing care supported a smooth recovery, highlighting the importance of early diagnosis and prompt multidisciplinary management in gastric volvulus.

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