A Case of Gastric Volvulus with Hepatic Portal Venous Gas and Gastric Perforation

Tetsuo Tsukahara, Masatoshi Isogai, Toru Harada, Yuji Kaneoka, Keitaro Kamei, Atsuyuki Maeda and Yu Takahashi

Department of Surgery, Ogaki Municipal Hospital

Gastric volvulus with hepatic portal venous gas and perforation is very rare, with only 1 case, to our knowledge, reported case to date. A 76-year-old woman with a history of Parkinson's disease and thoracoplasty for pulmonary tuberculosis admitted for sudden abdominal pain onset was found on physical examination to have abdominal distension with tenderness and muscular defense in the upper abdomen. Abdominal X-ray showed significantly dilated gastric air. Abdominal computed tomography (CT) also indicated prominent gastric dilatation, abdominal free air, and hepatic portal venous gas. She underwent emergency laparotomy under a diagnosis of gastrointestinal perforation. Operative findings showed mesenteroaxial volvulus of the stomach with perforation of the fundus, necessitating resection of the injured tissue and gastropexy. A postoperative left subphrenic abscess were treated by interventional radiology. The woman was discharged on postoperative day 45 with no sign of recurrence.

Key words
gastric volvulus, portal venous gas, perforation

Reprint requests
Tetsuo Tsukahara Department of Surgery, Ogaki Municipal Hospital
4-86 Minaminokawa-cho, Ogaki, 503-8502 JAPAN

Accepted
March 25, 2009

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