Authors: Dr Maryam Khan , dr Janath Wijesinghe

Abstract

Background:
Acute gastric volvulus is a rare but potentially life-threatening condition that requires prompt
recognition and management. Its non-specific clinical presentation often poses diagnostic
challenges, particularly in patients with predisposing anatomical anomalies such as a hiatus
hernia.

Case Presentation:
We report the case of a 48-year-old female who presented with a 24-hour history of sudden-
onset, continuous upper abdominal pain and vomiting. Her medical history included asthma
and gastritis secondary to a known hiatus hernia. Examination revealed upper abdominal
tenderness and bi-basal crepitations, predominantly on the right side. Laboratory
investigations showed elevated inflammatory markers, including a white cell count of 19.5
(neutrophils 16.9) and a CRP of 320.
A contrast-enhanced CT scan confirmed a large hiatus hernia complicated by gastric
volvulus, along with a right lower lobe pneumonia suggestive of aspiration. The patient was
managed conservatively with nasogastric decompression, intravenous fluids, and antibiotics,
and was referred for surgical evaluation.

Conclusion:
This case highlights the importance of maintaining a high index of suspicion for gastric
volvulus in patients with upper abdominal pain and a history of hiatus hernia. Early imaging
and multidisciplinary management are critical for optimal outcomes. Given its rarity and
variable presentation, this case contributes to raising awareness among emergency and
surgical teams.

Keywords: abdominal pain, hiatus hernia, gastric volvulus