title: Delayed diagnosis of intermittent mesenteroaxial volvulus of the stomach by computed tomography: a case report.
abstract: BACKGROUND
  Gastric volvulus is a rare condition. Presenting acutely, mesenteroaxial gastric volvulus has characteristic symptoms and may be easily detected with upper gastrointestinal contrast studies. In contrast, subacute, intermittent cases present with intermittent vague symptoms from episodic twisting and untwisting. Imaging in these cases is only useful if performed in the symptomatic interval.
  
  
  METHODS
  We describe a patient with a long history of intermittent chest and epigastric pain. An earlier barium meal was not diagnostic. Diagnosis was finally secured during the current admission by a combination of (1) serum investigations, (2) endoscopy, and finally (3) computed tomography.
  
  
  CONCLUSIONS
  Non-specific and misleading symptoms and signs may delay the diagnosis of intermittent, subacute volvulus. Imaging studies performed in the well interval may be non-diagnostic. Elevated creatine kinase and aldolase of a non-cardiac cause and endoscopic findings of ischaemic ulceration and difficulty in negotiating the pylorus may raise the suspicion of gastric volvulus. In this case, abdominal computed tomography with spatial reconstruction was crucial in securing the final diagnosis.
authors.affiliation: Department of General Surgery, Singapore General Hospital, Singapore. wolv23@gmail.com
authors.forename: Colin Yi-Loong
authors.initials: CY
authors.lastname: Woon
authors.forename: Alexander Yaw-Fui
authors.initials: AY
authors.lastname: Chung
authors.forename: Albert Su-Chong
authors.initials: AS
authors.lastname: Low
authors.forename: Wai-Keong
authors.initials: WK
authors.lastname: Wong