title: Gastric volvulus through morgagni hernia: an easily overlooked emergency.
abstract: BACKGROUND
  Intractable vomiting in an elderly patient is an emergency condition requiring prompt diagnosis and intervention. Acute gastric outlet obstruction due to gastric volvulus through Morgagni-type diaphragmatic hernia is an exceedingly rare cause of this nonspecific complaint.
  
  
  OBJECTIVE
  Our aim was to highlight that Morgagni hernia, although rare in adults, should be suspected in the appropriate clinical setting, and that a clue toward diagnosis often comes from routine chest and abdominal x-ray studies. In addition, we emphasize the atypical radiological findings and importance of emergency surgical intervention in such a case.
  
  
  METHODS
  We describe the case of a 78-year-old woman who presented to the Emergency Department with a 4-day history of intractable vomiting, and with no definitive clue to the diagnosis on examination. Her routine chest and abdomen x-ray studies suggested abnormal air-fluid level at right hemithorax, which prompted a computed tomography (CT) scan of the abdomen and an upper gastrointestinal contrast study. Gastric volvulus through a foramen of Morgagni was diagnosed and transthoracic reduction of the contents was performed, along with repair of the defect.
  
  
  CONCLUSIONS
  A symptomatic Morgagni hernia in adults, although rare, can present with a variety of symptoms ranging from nonspecific complaints of bloating and indigestion to the more severe complaint of intestinal obstruction. Gastric volvulus and obstructive features are less frequently reported as acute complications of these hernias, which need early identification and intervention.
authors.affiliation: Department of General Medicine, Medical College and Hospital, Kolkata, West Bengal, India.
authors.forename: Nikhil
authors.initials: N
authors.lastname: Sonthalia
authors.forename: Sayantan
authors.initials: S
authors.lastname: Ray
authors.forename: Dibbendhu
authors.initials: D
authors.lastname: Khanra
authors.forename: Avishek
authors.initials: A
authors.lastname: Saha
authors.forename: Subhasis
authors.initials: S
authors.lastname: Maitra
authors.forename: Manjari
authors.initials: M
authors.lastname: Saha
authors.forename: Arunansu
authors.initials: A
authors.lastname: Talukdar
mesh_terms: D000368:Aged; D001466:Barium Sulfate; D003287:Contrast Media; D004636:Emergency Service, Hospital; D005260:Female; D006548:Hernia, Diaphragmatic / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D006801:Humans; D001261:Pulmonary Atelectasis / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy; D013277:Stomach Volvulus / Q000175:diagnosis* / Q000209:etiology* / Q000601:surgery; D013526:Surgical Mesh; D014057:Tomography, X-Ray Computed; D014839:Vomiting / Q000209:etiology
chemical_list: D003287:Contrast Media; D001466:Barium Sulfate