title: Acute gastric volvulus associated with wandering spleen in an adult treated laparoscopically after endoscopic reduction: a case report.
abstract: A 43-year-old female was referred to our hospital for sudden onset of abdominal pain, fullness, and vomiting. Physical examination revealed abdominal distension with mild epigastric tenderness. Abdominal radiography showed massive gastric distension and plain computed tomography (CT) a markedly enlarged stomach filled with gas and fluid. A large volume of gastric contents was suctioned out via a nasogastric (NG) tube. Contrast-enhanced CT showed a grossly distended stomach with displacement of the antrum above the gastroesophageal junction, and the spleen was dislocated inferiorly. Upper gastrointestinal (GI) series showed the greater curvature to be elevated and the gastric fundus to be lower than normal. Acute mesenteroaxial gastric volvulus was diagnosed. GI endoscopy showed a distortion of the gastric anatomy with difficulty intubating the pylorus. Various endoscopic maneuvers were required to reposition the stomach, and the symptoms showed immediate and complete solution. GI fluoroscopy was performed 3 days later. Initially, most of the contrast medium accumulated in the fundus, which was drawn prominently downward, and then began flowing into the duodenum with anteflexion. Elective laparoscopic surgery was performed 1 month later. The stomach was in its normal position, but the fundus was folded posteroinferiorly. The spleen attached to the fundus was normal in size but extremely mobile. We diagnosed a wandering spleen based on the operative findings. Gastropexy was performed for the treatment of gastric volvulus and wandering spleen. The patient remained asymptomatic, and there was no evidence of recurrence during a follow-up period of 24 months. This report describes a rare adult case of acute gastric volvulus associated with wandering spleen. Because delay in treatment can result in lethal complications, it is critical to provide a prompt and correct diagnosis and surgical intervention. We advocate laparoscopic surgery after endoscopic reduction because it is a safe and effective procedure with lower invasiveness.
authors.affiliation: Department of Surgery, Japan Self-Defense Force Central Hospital, 1-2-24 Ikejiri, Setagaya-ku, Tokyo, 154-8532, Japan. omatajiro@yahoo.co.jp.|Department of Surgery, KKR Mishuku Hospital, 5-33-12 Kamimeguro, Meguro-ku, Tokyo, 153-0051, Japan. omatajiro@yahoo.co.jp.
authors.forename: Jiro
authors.initials: J
authors.lastname: Omata
authors.affiliation: Department of Surgery, Japan Self-Defense Force Central Hospital, 1-2-24 Ikejiri, Setagaya-ku, Tokyo, 154-8532, Japan.|Department of Surgery, KKR Mishuku Hospital, 5-33-12 Kamimeguro, Meguro-ku, Tokyo, 153-0051, Japan.
authors.forename: Katsuyuki
authors.initials: K
authors.lastname: Utsunomiya
authors.affiliation: Department of Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan.
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Kajiwara
authors.affiliation: Medical Office, Ministry of Defense, 5-1 Ichigayahonmura, Shinjuku-ku, Tokyo, 162-8801, Japan.
authors.forename: Risa
authors.initials: R
authors.lastname: Takahata
authors.affiliation: Department of Gastroenterology, KKR Mishuku Hospital, 5-33-12 Kamimeguro, Meguro-ku, Tokyo, 153-0051, Japan.
authors.forename: Nobuo
authors.initials: N
authors.lastname: Miyasaka
authors.affiliation: Department of Surgery, Japan Self-Defense Force Central Hospital, 1-2-24 Ikejiri, Setagaya-ku, Tokyo, 154-8532, Japan.
authors.forename: Hidekazu
authors.initials: H
authors.lastname: Sugasawa
authors.affiliation: Department of Surgery, Japan Self-Defense Force Central Hospital, 1-2-24 Ikejiri, Setagaya-ku, Tokyo, 154-8532, Japan.
authors.forename: Naoko
authors.initials: N
authors.lastname: Sakamoto
authors.affiliation: Department of Surgery, Japan Self-Defense Force Central Hospital, 1-2-24 Ikejiri, Setagaya-ku, Tokyo, 154-8532, Japan.|Department of Surgery, KKR Mishuku Hospital, 5-33-12 Kamimeguro, Meguro-ku, Tokyo, 153-0051, Japan.
authors.forename: Yoji
authors.initials: Y
authors.lastname: Yamagishi
authors.affiliation: Department of Surgery, Japan Self-Defense Force Central Hospital, 1-2-24 Ikejiri, Setagaya-ku, Tokyo, 154-8532, Japan.|Department of Surgery, KKR Mishuku Hospital, 5-33-12 Kamimeguro, Meguro-ku, Tokyo, 153-0051, Japan.
authors.forename: Makiko
authors.initials: M
authors.lastname: Fukumura
authors.affiliation: Department of Surgery, Japan Self-Defense Force Central Hospital, 1-2-24 Ikejiri, Setagaya-ku, Tokyo, 154-8532, Japan.
authors.forename: Daiki
authors.initials: D
authors.lastname: Kitagawa
authors.affiliation: Department of Surgery, Japan Self-Defense Force Central Hospital, 1-2-24 Ikejiri, Setagaya-ku, Tokyo, 154-8532, Japan.
authors.forename: Mitsuhiko
authors.initials: M
authors.lastname: Konno
authors.affiliation: Department of Surgery, Japan Self-Defense Force Central Hospital, 1-2-24 Ikejiri, Setagaya-ku, Tokyo, 154-8532, Japan.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Okusa
authors.affiliation: Department of Surgery, Japan Self-Defense Force Central Hospital, 1-2-24 Ikejiri, Setagaya-ku, Tokyo, 154-8532, Japan.
authors.forename: Michinori
authors.initials: M
authors.lastname: Murayama
keywords: Endoscopic reduction; Gastric volvulus; Gastropexy; Laparoscopic surgery; Wandering spleen