Organo-axial Gastric Volvulus.

An 84-year-old woman with known history of paraesophageal hiatal hernia presented with acute epigastric pain and vomiting. Laboratory testing revealed no clinically significant derangements. A computed tomography scan was performed, which revealed rotation of the stomach along its long axis with reversal of the greater and lesser curvatures, mimicking an inverted stomach appearance (Figure A). This finding was consistent with organoaxial gastric volvulus. The patient was emergently taken for laparotomy for detorsion of the stomach and gastropexy. Significant resolution of the patient’s symptoms was achieved at her 4-week follow-up appointment. Organoaxial gastric volvulus is a rare disease caused by malrotation of the stomach. Precipitating factors include anatomical disorders of the gastrointestinal tract or adjacent organs that may limit the fixation of the stomach to the abdominal wall. Paraesophageal hiatal hernia, as in the case described, is a common cause of organoaxial gastric volvulus. The mainstay of treatment involves open or laparoscopic detorsion with gastropexy. Partial or complete gastrectomy may be required in severe cases, such as in the presence of strangulation and necrosis.