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.