Concurrent large bowel obstruction secondary to idiopathic mesenteroaxial gastric volvulus

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A patient in her 60s presented to the emergency room with sudden-onset severe epigastric pain associated with nausea and emesis. The patient’s medical history was unremarkable; surgical history was notable only for a diagnostic laparoscopy without any additional intervention. Vital signs were within normal limits and physical examination was notable for abdominal distension and generalized tenderness without peritoneal signs. Laboratory values were notable for an elevated lactate of 2.9 mmol/L. On CT of the abdomen and pelvis, the patient was found to have a mesenteroaxial gastric volvulus with the markedly distended stomach causing mass effect on a very redundant colon (figure 1). There was concern for large bowel obstruction with a transition point at the splenic flexure. There was evidence of mesenteric edema, but no evidence of ischemia, pneumatosis, or pneumoperitoneum. Figure 1 Mesenteroaxial gastric volvulus. 1. Nasogastric tube …

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