title: [Laparoscopic gastric sleeve in gastric volvulus secondary to diaphragmatic eventration in an adult patient].
abstract: BACKGROUND
  Acute gastric volvulus is a rare, but potentially life-threatening, cause of upper gastrointestinal obstruction.
  
  
  METHODS
  Male of 60 years old with severe epigastric pain and abdominal distension with haematemesis on two occasions. The patient was haemodynamically stable, with abdominal distension and palpable epigastric fullness. Hematic cytology showed: haemoglobin 8.2g/dl and haematocrit 27%. Abdominal X-ray showed an elevation of left diaphragm with a hugely dilated stomach. A nasogastric tube was inserted. Endoscopy was performed. There was no active bleeding, but it was impossible to reach the duodenum due to the stomach distortion. The upper gastrointestinal X-ray study showed the appearance of an inverted stomach in the chest and an organoaxial gastric torsion. The CT scans of thorax and abdomen showed a gastric ascent into the thoracic cavity. Laparoscopic surgery was performed, finding the left hemi-diaphragm elevated, and the stomach, splenic angle of the colon, the spleen and tail of the pancreas were also raised. A linear gastrectomy (gastric sleeve) was performed. The postoperative progress was satisfactory. Oral feeding was started 72 hours after surgery, and the patient was discharged, and has remained asymptomatic during the following by 8 years.
  
  
  CONCLUSIONS
  Emergency physicians must maintain a high level of suspicion in patients that present with signs and symptoms suggesting upper digestive tract occlusion. The gastric sleeve is an excellent alternative to avoid recurrence of gastric volvulus.
authors.affiliation: Servicio de Gastrocirugía, Hospital Ángeles León, Guanajuato, México. Electronic address: vgalvez@angelesleon.com.
authors.forename: Ramiro
authors.initials: R
authors.lastname: Gálvez-Valdovinos
authors.affiliation: Servicio de Gastrocirugía, Hospital Ángeles León, Guanajuato, México.
authors.forename: Ernesto
authors.initials: E
authors.lastname: Marín-Santillán
authors.affiliation: Servicio de Gastrocirugía, Hospital Ángeles León, Guanajuato, México.
authors.forename: Juan Francisco
authors.initials: JF
authors.lastname: Funes-Rodríguez
authors.affiliation: Servicio de Gastrocirugía, Hospital Ángeles León, Guanajuato, México.
authors.forename: Gustavo
authors.initials: G
authors.lastname: López-Ambriz
mesh_terms: D003965:Diaphragmatic Eventration / Q000150:complications*; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D013277:Stomach Volvulus / Q000209:etiology* / Q000601:surgery*
keywords: Diaphragmatic eventration; Eventración diafragmática; Gastrectomía lineal; Gastric sleeve; Gastric volvulus; Linear gastrectomy; Manga gástrica; Vólvulo gástrico