Joining the Big Five: Adding Gastric Volvulus in a Para-Esophageal Hernia to the List of Potentially Fatal Causes of Chest Pain

Sree Sruthi Kowsika, MD*, UPMC, Monroeville, PA; Sofiya Rehman, MD, UPMC-McKeesport, Mckeesport, PA; Ibrahim Ghobrial, University Of Pittsburgh Medical Center, McKeesport, PA and Faiza Khalid, MD, UPMC-McKeesport, Monroeville, PA

Meeting: Hospital Medicine 2016, March 6-9, San Diego, Calif.

Abstract number: 627

Categories: Adult, Clinical Vignettes Abstracts

Keywords: ,

Case Presentation: A 62-year-old female with no known past medical history presented with 3-days of multiple episodes of vomiting after consuming Chinese food.She was in atrial fibrillation with a rapid ventricular response.Significant lab analyses included lactate of 13 mg/dL,WBC of 26,000 /µL with left shift, Cr of 3.4 mg/dL,BUN of 48 mg/dL, and Troponin of 0.104 ng/mL.She showed initial improvement with fluid resuscitation and rate control,but symptoms rapidly recurred, accompanied by massive hematemesis.Following gastric decompression by an NG tube,a CT-scan showed paraesophageal hernia with organoaxial gastric volvulus.She received endoscopic reduction, followed by definitive surgery with closure of the diaphragmatic hiatus,gastropexy and partial gastrectomy of the ischemic portion of the stomach. 

Discussion: Gastric volvulus is a rare and potentially life threatening condition unless promptly treated. Diagnosis can be delayed due to the non-specificity and the oscillating nature of the symptoms.Early diagnosis is possible through rapid consideration in at-risk patients, and attention to radiological findings.Risk factors to be conscious of include hiatal hernia, diaphragm eventration, and phrenic nerve palsy. Patients may present with abdominal pain, chest pain, and vomiting.Most patients require immediate NG or endoscopic decompression followed by surgical repair.This case underscores the importance of early diagnosis to avoid extensive surgical resection

Conclusions: Gastric volvulus is a life threatening condition  if left undiagnosed and has a high mortality rate of 30%. This case underscores the importance of early diagnosis and repair of such cases

To cite this abstract:

Kowsika SS, Rehman S, Ghobrial I, Khalid F. Joining the Big Five: Adding Gastric Volvulus in a Para-Esophageal Hernia to the List of Potentially Fatal Causes of Chest Pain. Abstract published at Hospital Medicine 2016, March 6-9, San Diego, Calif. Abstract 627. Journal of Hospital Medicine. 2016; 11 (suppl 1). https://www.shmabstracts.com/abstract/joining-the-big-five-adding-gastric-volvulus-in-a-para-esophageal-hernia-to-the-list-of-potentially-fatal-causes-of-chest-pain/. Accessed December 8, 2019.

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