Intrathoracic gastric volvulus: an autopsy case report

Ano: 2013 | Volume: 3 | Número: 2

Autores: C. R. Ferreira, L. F. Maximiano, V. M. L. Santos, J. A. S. Martines

Palavras-chave: stomach volvulus, abdominal pain, mediastinitis, pancreatitis, shock septic

Resumo Inglês:

First described by Berti in 1866, gastric volvulus (GV) is an uncommon and
potentially lethal entity. GV occurs when the stomach twists by more than 180º
resulting in obstruction of the alimentary tract, visceral ischemia, necrosis,
and perforation. It is classified according to the rotation axis in organoaxial,
mesenteroaxial or a combination of both. The clinical presentation can be acute,
and is usually severe or chronic, which sometimes may be asymptomatic. It
predominantly occurs in the fifth decade of life, but children, mainly those under
the age of 1 year, may be affected. No ethnicity or gender was observed to show
predominance. This entity is related to gastric, diaphragmatic disorders as
well as laxity of gastric ligaments. Acute GV may complicate with incarceration
and strangulation of the stomach when gastric necrosis ensues. These cases
show a mortality rate of 60%. The authors report the fatal case of a surgically
treated GV in a 43-year-old female patient who looked for medical care only
after 1 month of initial symptoms. Diagnosis was confirmed with a thoracic
and abdominal axial computed tomography. Besides the entire stomach being
herniated and twisted into the thoracic cavity, the pancreas was pulled up
through the hiatal orifice, provoking acute pancreatitis. Because of gastric
necrosis and perforation, gastroenteric fluid drained into the mediastinum and
left pleural space. The postoperative outcome was unfavorable resulting in the
patient’s death. The authors call attention to the severeness of the disease,
and therefore the need of precocity of diagnosis and surgical treatment.