A Rare Case of Gastric Volvulus with Hiatal Hernia

​BY FAHAD SHAH & AHMED RAZIUDDIN, MDA 68-year-old woman presented with acute abdominal pain that had started three hours earlier. She said she had constant upper abdominal pain that was sharp and stabbing, and she rated her pain as 8/10.The patient said the pain did not radiate, and she was clearly in acute distress. She reported that her last meal had been four hours before and that she was nauseated and had had three to four episodes of dry heaves.She had no other concerning symptoms, and her pain was unaffected by eating, drinking, or position. She had a paraesophageal rolling hiatal hernia and was aware of her chronic condition, but had not sought treatment because it was not overtly symptomatic besides mild GERD and indigestion.She had a blood pressure of 156/100 mm Hg, a pulse of 70 bpm, a respiratory rate of 20 bpm, and an oxygen saturation of 97% on room air. Her pain was above the umbilical region, and she was in a left lateral decubitus position to cope with the pain. The examination revealed upper abdominal tenderness, minimal distention, and normal bowel sounds without guarding or rebound tenderness.She was given ondansetron 4 mg, morphine 4 mg, and IV fluids. The patient's blood panel showed a low RBC count of 4.15 m/uL, a hemoglobin of 11.7 g/dL, and a slightly decreased hematocrit of 36.4%. Her neutrophils were high at 82.5%, lymphocytes were low at 14.5%, and glucose was elevated at 162 mg/dL. Her lactic acid and lipase were elevated at 2.4 mmol/L and 12...
Source: The Case Files - Category: Emergency Medicine Tags: Blog Posts Source Type: research