Critical Care and Shock

Gastric volvulus herniation in the chest

An 80 year-old lady with a history of hypertension and hypothyroidism presented to emergency department (ED) with complaints of shortness of breath, epigastric discomfort, difficulty swallowing and poor appetite for a period of three weeks. She was only able to eat a soft diet and clear liquids. A chest radiograph in the ED revealed a large hernia, which was seen extending from the right hemidiaphragm across the midline into the left hemidiaphragm, likely representing a combination of a diaphragmatic hernia with a hiatal hernia and possible gastric volvulus (Figure 1). A computed tomography (CT) scan of the chest and abdomen revealed a large and distended hollow viscus structures filling the lower chest and upper abdomen. The CT was suggestive of organoaxial gastric volvulus with marked dilatation of the stomach (Figures 2 and 3). Barium swallow also showed findings compatible with organoaxial gastric volvulus.

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