Rajwana Yasir, Ezeh Kosisochukwu J, Ott William, Spira Etan
Internal Medicine, Jersey City Medical Center, Jersey City, USA.
Gastroenterology and Hepatology, Jersey City Medical Center, Jersey City, USA.
Cureus. 2022 Jul 18;14(7):e26976. doi: 10.7759/cureus.26976. eCollection 2022 Jul.
Gastric volvulus is a distinct and uncommon pathology that usually presents with vomiting secondary to gastric outlet obstruction and gastrointestinal bleeding with an association with hiatal hernia. We present a case of a 71-year-old female who presented to the emergency department (ED) with a three-day history of coffee ground emesis. Of note, the patient was recently in the hospital under medical observation two weeks prior, with similar complaints of hematemesis. Chest X-ray revealed a left basilar opacity representing bowel gas suggestive of a hiatal hernia. Intravenous proton pump inhibitors were initiated but due to persistent recurrence of symptoms and progressive discomfort, a computed tomography (CT) of the chest and abdomen was ordered. This revealed a partial gastric volvulus with signs suggestive of vascular compromise of the herniated part of the stomach. She subsequently underwent emergent laparotomy, repair of the hiatal hernia, and partial gastrectomy and gastropexy. Post-surgical biopsy findings showed focal mucosal necrosis and ulceration, focal foveolar hyperplasia, edematous changes, and overall congestion in the submucosal tissue. She was discharged five days later with no complications or recurrence of symptoms.
胃扭转是一种独特且不常见的病理状况，通常表现为继发于胃出口梗阻的呕吐以及与食管裂孔疝相关的胃肠道出血。我们报告一例71岁女性患者，她因有三天咖啡渣样呕吐史就诊于急诊科。值得注意的是，该患者两周前曾因类似呕血症状在医院接受医学观察。胸部X线显示左基底段有代表肠气的不透光区，提示食管裂孔疝。开始静脉给予质子泵抑制剂，但由于症状持续复发且不适加重，遂安排了胸部和腹部的计算机断层扫描（CT）。结果显示为部分胃扭转，并有提示胃疝出部分血管受压的征象。她随后接受了急诊剖腹手术、食管裂孔疝修补术、部分胃切除术和胃固定术。术后活检结果显示局部黏膜坏死和溃疡、局部小凹增生、水肿改变以及黏膜下组织整体充血。五天后她出院，无并发症且症状未复发。
