An 80-year-old woman, without comorbidities, was admitted to the Emergency Department for violent epigastric pain, which had arisen about 24 h before, after the meal, associated at first with coffee vomiting and, subsequently, with unproductive retching and oligoanuria. For some years now, she reported a lack of appetite, postprandial abdominal bloating, difficulty erupting and, sporadically, intermittent epigastric pain that she treated with self-medicated drugs.

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Examination

Physical examination showed severe dehydration. Temperature: 37.8 &deg;C. BP: 90/50 mmHg. HR: 140 bpm. GCS: 8. Marked tenderness at palpation of all the abdominal quadrants, with signs of peritonism. Anuric patient. Blood tests showed neutrophilic hyperleukocytosis (WBC: 30,000/mm3), an increase in creatinine (1.47 mg/dl), CRP (139.7 mg/l) and LDH (504 IU/l) values. CT of the thorax and abdomen with contrast showed a voluminous sliding hiatal hernia with herniation of nearly the entire stomach in the retrocardiac seat. A possible diagnosis of acute gastric volvulus was made. The presence of retrograde gastro-gastric invagination at the level of the antrum was also reported.

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