Physical examination reveals abdominal tenderness and hypotension. A mesenteroaxial volvulus of the stomach with high grade partial, if not complete, gastric outlet obstruction is documented. One can see a very narrow column of contrast defining the pylorus which is just to the left of the paraesophageal hernia. At surgery, a mesenteroaxial volvulus was confirmed and repair performed.
Gastric volvulus is an acquired twist of the stomach that can lead to gastric outlet obstruction.
It may be associated with a large esophagus, or a paraesophageal hernia that permits part of the stomach to extend into the chest. It does not exceed 180 degrees. There is rotation of the stomach upward around its long axis so the antrum changes from the inferior to a superior position with the greater curve higher than the lesser curvature of the stomach. This type is more common in children. The classic clinical triad is violent retching without vomitus, severe epigastric pain and difficulty passing an NG tube past the distal esophagus.