Gastric volvulus – a rare cause of abdominal pain

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We describe two illustrative cases of acute and primary gastric volvulus: Case 1: A 24-year-old male went to the Emergency Department due to postprandial vomiting in the last 4 days. Abdominal X-ray showing gastric dilatation. A nasogastric tube was placed for drainage, with improvement, and he was discharged. Six months later, he returned to the Emergency Department for the same reason. A nasogastric tube was placed, with vestigial drainage. An abdominal CT scan revealed liquid and gaseous distension of the gastric cavity, associated with torsion. Upper gastrointestinal endoscopy revealed a distended gastric lumen with abundant food content, with torsion making it difficult to move the endoscope forward, which was possible after decompression. Mucosa of the gastric body with a vinous appearance and superficial ulceration. He starts on antibiotic therapy and with a favorable evolution, awaiting scheduled surgical intervention. Case 2: A 90-year-old male came to the Emergency Department with diffuse abdominal pain, associated with nausea and vomiting. Abdominal CT scan showing voluminous gastrectasia with hydroaerial level, with apparent rotation.Upper digestive endoscopy revealed a distended lumen with abundant food content and clockwise luminal torsion, which was successfully reduced with counterclockwise progression of the endoscope.He showed clinical improvement, with food tolerance and no vomiting.Asymptomatic to date. Gastric volvulus is a rare entity. We present 2 primary gastric volvulus with mesentero-axial torsion. Gastroscopy is a useful diagnostic and therapeutic tool in selected cases of gastric volvulus, allowing decompression, de-rotation and exclusion of significant ischemia. Publication History Article published online: 27 March 2025 © 2025. European Society of Gastrointestinal Endoscopy. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

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