Gastric Volvulus with Torsion of Wandering Spleen: A Rare Case of Acute Abdomen

Abstract

Gastric volvulus with splenic torsion presenting as acute abdomen is a rare entity. Gastric volvulus is characterised by rotation of more than 180° either along long axis (organo-axial) or short axis (mesentrico-axial), resulting in partial or complete obstruction of the gastric lumen. If untreated, it results in strangulation, ischemia, necrosis, and finally gastric perforation with increased mortality. Wandering spleen is also a rare entity characterised by underdevelopment or absence of one or all of the ligaments that hold the spleen in its normal position, which may rarely lead to splenic torsion. It requires urgent diagnosis and treatment to overcome life threatening complications. Here we report a case of a 17-year-old females patient with acute gastric volvulus, presenting with perforative peritonitis with torsion of wandering spleen as seen in Contrast enhanced computed tomography of abdomen which showed pneumoperitoneum, raised left dome of diaphragm with organo-axial gastric volvulus, with non-visualisation of spleen in its normal position with ascites. Upper GI Endoscopy confirmed that visualised part of mucosa to be gangrenous, scope was partially negotiable till fundus. Patient was posted for emergency laparotomy. On laparotomy-spleen was seen anterior to fundus and gangrenous with visible torsion of splenic pedicle.

Keywords

• gastric lumen
• perforative peritonitis
• splenic torsion