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AN INTERESTING

CASE OF

VOMITINGDepartment of Medical GastroenterologyMadras Medical College

Chennai - 3

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HISTORY

MRS. N

80/F

CHENNAI

PRESENTING COMPLAINTS

PAIN ABDOMEN 4 YEARS.

VOMITING 4 YEARS.

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HISTORY

PAIN ABDOMEN, BURNING IN NATURE,NOT RADIATING, INCREASING WITHFOOD INTAKE & RELIEVED BYVOMITING, NO NOCTURNAL PAIN.

VOMITING INTERMITTENT, INDUCEDVOMITING.

H/O HEART BURN.

H/O HOLD UP IN LOWER CHEST.

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HISTORY

APPETITE REDUCED.WEIGHT STABLE. BOWEL HABITS REGULAR.

NO H/O GI BLEED.

MICTURITION NORMAL.

NO H/O FEVER, JAUNDICE OR DRUG

INTAKE (NSAID).

NO PAST H/O DM, HT, PT, IHD, COPDOR BLOOD TRANSFUSION.

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EXAMINATION NO PALLOR, ICTERUS, PEDAL EDEMA

PULSE: 80 / MIN BP: 130 / 80 mm of Hg

CVS: NORMAL.

RS: NORMAL.

CNS: NORMAL

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EXAMINATION

ABDOMEN:

NO DISTENSION, VGP OR VIP

FLANKS FREE

UMBILICUS NORMAL NO ENGORGED VEINS

TENDERNESS PRESENT OVER THE

EPIGASTRIC REGION NO ORGANOMEGALY

NO FREE FLUID

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INVESTIGATIONS

HB%: 9.6 gm, TC: 8600, DC: P56 L42 E2,ESR:12mm / Hr.

URINE: ALB, SUG, DEP : NIL

MOTION: OVA,CYST, OB : NIL

UREA: 18 mg%, SUGAR: 110mg%,CREATININE: 0.8mg%

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UGI ENDOSCOPY

OESOPHAGUS NORMAL. INABILITY TO PASS BEYOND CARDIA

AND FUNDUS INTO THE BODY OF THE

STOMACH. SCOPE PASSED DISTALLY WITH

DIFFICULTY, BY KEEPING THE PATIENTIN RIGHT LATERAL POSITION.

EROSIVE ANTRAL GASTRITIS.

NORMAL BULB AND D 2.

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RADIOLOGY

PLAIN X RAY ABDOMEN.

BARIUM MEAL STUDY.

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FINAL DIAGNOSIS

CHRONIC GASTRIC VOLVULUS

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DEFINITION

The term Volvulusrefers to an acquiredtwist of a viscus on itself and is derivedfrom the Latin word volvere, meaning totwist around.

Gastric volvulus is defined as anabnormal degree of rotation of one part

of the stomach around another.

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CLINICAL FEATURES

Acute volvulus

Borchardts triad

Severe epigastric pain and distension

Violent nonproductive retching Inability to pass a Ryles tube.

Chronic volvulus

Symptomless

Incidental finding

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CLASSIFICATIONType Organoaxial

Mesenterioaxial

Combination

Extent

Total Partial

Direction

Anterior

Posterior

Onset Acute

Chronic

Aetiology

Idiopathic

Secondary

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AXIS OF ROTATION1. MESENTREROAXIAL

2. ORGANOAXIALALONG THEBODY.

3. ORGANOAXIALALONG THE

GASTROESOPHAGEALAND PYLORICAXIS

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ORGANOAXIAL VOLVULUS

The rotation may occur around a linejoining the pylorus to theoesophagogastric junction.

The greater curvature usually swings

anteriorly and upward so that theposterior surface of the stomachbecomes the anterior.

This rotation results in an upside-downstomach, with the greater curvature onthe top and the lesser curvature on thebottom.

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MESENTEROAXIAL VOLVULUS

The axis of rotation is a horizontal linethat runs from the center of the greatercurvature to porta hepatis.

The pyloroantral area rotates from rightto left so that the posterior surface of thestomach becomes the anterior.

In this the stomach is right-side-up, butbackward.

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INVESTIGATION Plain x ray abdomen

Upper GI endoscopy

Barium meal series

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TREATMENTACUTE VOLVULUS

SURGERY

ENDOSCOPY

CHRONIC VOLVULUS

CONSERVATIVE

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