# Secondary Mesenteroaxial Gastric Volvulus in an Elderly Female: A Rare Presentation of an Occult Diaphragmatic Hernia

## TL;DR

An elderly woman with a rare stomach twist caused by a hidden diaphragm hole was successfully treated surgically.

## Contribution

This case report highlights a rare presentation of mesenteroaxial gastric volvulus linked to an occult diaphragmatic hernia in an elderly patient.

## Key findings

- A 70-year-old woman presented with acute gastric volvulus and a previously undiagnosed diaphragmatic hernia.
- Emergency surgery included detorsion, repair of the hernia, and gastropexy to prevent recurrence.
- The case underscores the importance of early diagnosis and intervention in occult diaphragmatic defects in the elderly.

## Abstract

Gastric volvulus is a surgical emergency characterized by rotation of the stomach greater than 180°, potentially leading to ischemia and perforation. Mesenteroaxial volvulus associated with a late-presenting diaphragmatic hernia in adults is an uncommon clinical entity.

A 70-year-old woman with diabetes presented with acute abdominal distension and lactic acidosis. Nasogastric decompression yielded 3 L of coffee-ground aspirate, and computed tomography (CT) identified a mesenteroaxial gastric volvulus. Emergency laparotomy revealed a left-sided diaphragmatic hernia containing the gastric antrum and pylorus. Management included detorsion, reinforcement of a focal ischemic area on the posterior gastric wall, diaphragmatic repair, and gastropexy.

This case highlights the silent nature of congenital diaphragmatic defects in the elderly, which can present as life-threatening acute scenarios. It emphasizes the importance of immediate and adequate resuscitative measures, coupled with early diagnosis and definitive treatment.