Second-look laparostomy for perforated gangrenous gastric volvulus to prevent total gastrectomy.

Abstract

A 42-year-old Caucasian woman presented to the emergency department with severe upper abdominal pain and vomiting. Clinically, she was septic, and abdominal examination suggested peritonitis. Following immediate resuscitation, the patient was stabilised and underwent urgent contrast-enhanced CT of the abdomen and pelvis. This revealed a mesenteroaxial gastric volvulus with traction on the mesentery and a small volume of free fluid. She underwent laparotomy revealing gangrenous gastric fundus perforation complicated by persistent intraoperative hypotension. This mandated a damage-control approach for the patient's safety entailing a limited-sleeve gastrectomy and laparostomy formation. Stabilisation in the intensive care unit allowed for a safer return to the operating room. On second look 24 hours later, previously ischaemic non-viable-looking portions of the stomach had recovered their blood supply. The patient was discharged 31 days postoperatively after recovering from the operations, postoperative wound infections and pleural effusions.

• Authors: Paul K Okeny, Omar Abbassi, Ali Warsi
• Journal: BMJ case reports (BMJ Case Rep) Vol. 2018 (May 15 2018) ISSN: 1757-790X [Electronic] England
• PMID: 29764844 (Publication Type: Case Reports, Journal Article)
• Copyright: © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Topics

• Abdominal Pain (etiology)
• Acute Disease
• Adult
• Conservative Treatment
• Female
• Gangrene (complications, surgery)
• Gastrectomy
• Gastroscopy
• Humans
• Laparotomy
• Pleural Effusion (complications, diagnostic imaging)
• Second-Look Surgery (methods)
• Stomach Volvulus (complications, diagnostic imaging, pathology, surgery)
• Tomography, X-Ray Computed