Basak Bappy, Hasan M Tasdik, Stauber Jessica, Gupta Amit Sen, Islam Safiqul, Akther S M Quamrul
Shaheed Suhrawardy Medical College & Hospital, Dhaka, Bangladesh.
Department of Psychological Sciences, University of Liverpool, United Kingdom.
Int J Surg Case Rep. 2020;72:443-447. doi: 10.1016/j.ijscr.2020.06.006. Epub 2020 Jun 15.
Gastric volvulus is a rare medical emergency that can be fatal if not recognized early. Its rarity makes it quite challenging to diagnose but delaying in diagnosis and treatment can lead to fatal complications. Meticulous assessment and broadened differential diagnosis are thus crucial. Organoaxial volvulus, in which the stomach rotates 180 degrees around its long axis, is the most common subtype of gastric volvulus, occurring predominantly in infants and older adults.
Here, we present a case of acute organoaxial gastric volvulus in a 17-year-old male presenting to a low-resource hospital in Bangladesh with severe upper abdominal pain and postprandial vomiting. Initial assessment revealed severe epigastric tenderness and mild dehydration. Plain abdominal x-ray showed a hugely distended bowel with single air fluid level and thoracic herniation of the stomach. The patient was resuscitated then sent to the operating theatre for urgent laparotomy and sleeve gastrectomy with anterior gastropexy. Treatment was successful, and the patient survived.
Acute gastric volvulus, a life-threatening surgical emergency can be treated successfully if identified timely. Though the CT scan is diagnostic, Borchardt's triad can be helpful as well.
This is the second consecutive case managed by the same surgeon in the same hospital, highlighting that high index of clinical suspicion is an important tool to diagnose this condition early. Timely diagnosis and treatment are essential to avoid fatal complications, denoting the importance of documenting such cases.
胃扭转是一种罕见的医疗急症，如果不及早识别可能会致命。其罕见性使其诊断颇具挑战性，但诊断和治疗的延迟可能导致致命并发症。因此，细致的评估和拓宽鉴别诊断至关重要。器官轴型胃扭转是胃扭转最常见的亚型，胃围绕其长轴旋转180度，主要发生于婴儿和老年人。
在此，我们报告一例17岁男性急性器官轴型胃扭转病例，该患者因严重上腹痛和餐后呕吐就诊于孟加拉国一家资源匮乏的医院。初步评估显示上腹部压痛严重且有轻度脱水。腹部平片显示肠管极度扩张，有单个气液平面，胃疝入胸腔。患者经复苏后被送往手术室进行紧急剖腹手术及袖状胃切除术并加做前胃固定术。治疗成功，患者存活。
急性胃扭转是一种危及生命的外科急症，如果及时识别可成功治疗。虽然CT扫描具有诊断价值，但博查特三联征也可能有所帮助。
这是同一位外科医生在同一家医院连续处理的第二例病例，突出表明高度的临床怀疑指数是早期诊断该病的重要工具。及时诊断和治疗对于避免致命并发症至关重要，这表明记录此类病例的重要性。
