Gastric volvulus due to diaphragmatic eventration and paraesophageal hernia

Acute gastric volvulus occurs when the stomach or a part of it rotates more than 180 degrees. It is a potentially life-threatening entity and most cases of gastric volvulus occur in association with eventration of left hemidiaphragm or a hiatal hernia. Gastric volvulus is a rare condition and presents with nonspecific epigastric pain and vomiting, and therefore may be missed. Chest x-ray and CT can help the diagnosis. Emergent surgical approach is mandatory. Two elderly patients admitted to ED with epigastric pain and intractable vomiting did not respond to the treatment and we were not able to pass nasogastric tube. We saw diaphragmatic eventration in their chest x-rays and ordered thoracoabdominal CT. CT revealed hiatal hernia and gastric volvulus in the first patient. In the second patient, there were gastric volvulus, moved colon into the mediastinum and dilatation of stomach. Both cases underwent emergent surgery and both of them were discharged healthy. Acute gastric volvulus carries a mortality rate of 42–56%, secondary to gastric ischemia, perforation or necrosis. Emergency physicians should have suspicion about gastric volvulus when treating patients with abdominal pain and persistent vomiting. The threshold should be kept low for surgical consultations.