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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MediSage Case Discussions

An 80-year-old woman presents with severe abdominal pain and dehydration, diagnosed with acute gastric volvulus and sliding hiatal hernia.

Acute Gastric Volvulus in an Elderly Patient

Epigastric pain associated with vomiting, retching, oligoanuria and death

Clinical case discussion shared for educational purposes and professional medical opinion.

Epigastric pain associate...