Case ReportA case report on gastric volvulus of a 17 years old boy from Bangladesh

- This rare and true surgical emergency was found in a 17 year old boy in Bangladesh
- It was the first case of gastric volvulus managed by the surgery department of the hospital.
- Laparotomy and anterior gastropexy with plication of left hemi diaphragm was done.
- It can manifest as an acute or chronic intermittent abdominal problem requiring proper investigation.
- It should be suspected in congenital abnormalities of the diaphragm and can be associated with ectopic kidneys.

IntroductionGastric volvulus is a rare and true surgical emergency which is life threatening if not recognized and treated quickly. There have been approximately 300 reported cases globally till now. This condition most often occurs during 5th decade of life but there are over 100 reported pediatric cases also. This following rare incidence was such a case of a young patient in Bangladesh. It was the first case of gastric volvulus managed by the surgery department of the concerned hospital.Presentation of caseA 17 year old boy with frequent post meal vomiting presented with abdominal fullness and mild upper abdominal pain for 2 months. He was absolutely constipated for 2 weeks. On examination, there was distension of abdomen with mild tenderness. He had no significant respiratory distress. Plain X-ray revealed elevation of left hemi-diaphragm. The contrast meal study showed organoaxial volvulus of stomach. Elevation of left hemidiaphragm and an ectopic subdiaphragmatic kidney was found in CT scan of chest.DiscussionAfter adequate preparation, the patient was subjected to laparotomy and anterior gastropexy with plication of left hemi diaphragm was done. Gastric volvulus can manifest as an acute abdominal emergency or as a chronic intermittent problem. It requires a high index of suspicion and proper investigation.ConclusionIt should be suspected in congenital abnormalities of diaphragm and associate with many other congenital abnormalities like ectopic kidney. Early surgical repair remains the treatment of choice.