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Case Report
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| Epigastric pain: Incarceration or rotation? | ||||||
| Ana Franky Carvalho1, Ana João Rodrigues2, Pedro Leão3 | ||||||
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1MD, PhD, Serviço de Cirurgia Geral - Hospital de Braga, Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal.
2PhD, Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal. 3MD, Ph.D, Serviço de Cirurgia Geral - Hospital de Braga, Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal. | ||||||
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| How to cite this article |
| Carvalho AF, Rodrigues AJ, Leão P. Epigastric pain: Incarceration or rotation? Int J Case Rep Images 2015;6(3):145–148. |
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Abstract
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Introduction:
Acute intrathoracic gastric volvulus occurs when the stomach has a twist mesenteroaxial/organoaxial or chest cavity resulting in a dilatation or rupture of the diaphragmatic hiatus or diaphragmatic hernia. The purpose of this work is to show a interesting case of gastric volvulus in a patient with several comorbidities.
Case Report: A 77-year-old female with past history of hiatal hernia and mental disease associated with diabetes and atrial fibrillation. Patient went to the emergency department due to vomiting associated with blood. Analytical parameters (WBC, HGB, PCR, metabolic panel and liver function), showed no significant alterations. Thoracic X-ray revealed an enlarged mediastinum due to herniation of the stomach. A computed tomography (CT) scan confirmed intrathoracic localization of the gastric antrum with twist. Patient's symptoms were relieved by nasogastric intubation and analgesia. After six months, the patient is still asymptomatic. Conclusion: In general, the treatment of an acute gastric volvulus requires an emergent surgical repair. In patients who are not surgical candidates (with comorbidities or an inability to tolerate anesthesia), endoscopic reduction should be attempted. Chronic gastric volvulus may be treated non-emergently, and surgical treatment is increasingly being performed using a laparoscopic approach. In this case, it is a chronic form that was solved with the placement of the nasogastric tube. A nasogastric decompression is an option in the chronic form of hiatal hernia associated to gastric volvulus in patients with serious comorbidities. | |
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Keywords:
Epigastric pain, Gastric volvulus, Hiatal hernia, Mesenteroaxial, Nasogastric tube
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Author Contributions
Ana Franky Carvalho – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published Ana João Rodrigues – Acquisition of data, Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published Pedro Leão – Acquisition of data, Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published |
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Guarantor of submission
The corresponding author is the guarantor of submission. |
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Source of support
None |
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Conflict of interest
Authors declare no conflict of interest. |
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Copyright
© 2015 Ana Franky Carvalho et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information. |
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