Mesenteroaxial gastric volvulus associated with a wandering spleen in an older woman treated with anterior gastropexy and splenectomy: a case report.
Hirotaka Nomiya, Kazuya Ofuji, Takuto Nosaka et al.
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Case in brief
An 80-year-old woman with Parkinson disease developed sudden abdominal and back pain with vomiting during a meal. CT showed marked gastric dilatation and rotation of the antrum, consistent with mesenteroaxial gastric volvulus, alongside an ectopic spleen near the greater curvature with suspected pedicle torsion. Endoscopy decompressed and temporarily detorsed the stomach, but it immediately retorsed. On hospital day 2, the stomach was reduced and secured with anterior gastropexy, and splenectomy was performed because of marked mobility and concern for recurrent torsion. Histology showed congestion and partial hemorrhagic infarction compatible with splenic torsion. Recovery was uneventful, with no recurrence during follow-up.
What made this case unusual
The gastric volvulus co-occurred with a wandering spleen, and the stomach retorsed immediately after endoscopic reduction. Splenic histology also showed changes compatible with torsion.
Diagnostic / clinical pearl
When gastric volvulus retorses immediately after endoscopic reduction, this case supports considering prompt definitive surgery. Management of an associated wandering spleen may depend on its mobility and viability.