Acute Volvulus of the Stomach in an Elderly Woman-A Case Report

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  • 高齢者に生じた急性胃軸捻転症の1例

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Abstract

An 87-year-old woman with a history of senile dementia was admitted to our hospital with vomiting, epigastralgia and abdominal distention. Endoscopic examination of the upper gastrointestinal tract revealed a large quantity of saburra in a twisted stomach. CT showed a highly expanded esophagus and stomach, the gastric fornix on the right side, and the gastric body on the left with a blockage distally. Upper gastrointestinal tract (UGI) examination confirmed these CT findings, showing a tapering blockage located in the gastric body. Based on these findings our diagnosis was a volvulus of the stomach. Informed consent could not be obtained, so conservative treatment was administered. However, abdominal pain developed on the seventh day, and esophagogastroduodenoscopy (EGD) showed severe ischemia of the stomach, yielding a preoperative diagnosis of a volvulus of the stomach with necrosis. We then performed an emergency laparotomy. Perioperative findings revealed that the stomach was twisted around the mesenteric axis and mostly necrotized, so we decided to perform total gastrectomy with Roux-Y reconstruction. Since there were no other aberrations, we concluded that the patient had an idiopathic volvulus of the stomach. The postoperative course was satisfactory. Our discussion includes a review of the relevant literature and how we might have improved our treatment.

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