Gastric remnant mesentero-axial volvulus following Roux-en-Y esophagojejunostomy: A rare complication

Grubic, Andrew D.; Ohde, Jane; Ayazi, Shahin; Jobe, Blair A.

INTRODUCTION: Acute gastric volvulus is a surgical emergency with a mortality as high as 15–20%. The rarity of gastric volvulus requires high index of clinical suspicion especially in the patients with altered anatomy, to allow immediate surgical intervention and reduce the morbidity and mortality. PRESENTATION OF CASE: We present an unusual case of gastric remnant volvulus several months following Roux-en-Y esophagojejunostomy performed in an obese patient for severe, recurrent gastroesophageal reflux disease (GERD) and failed prior fundoplication. The patient was treated with gastropexy and Stamm gastrostomy tube. DISCUSSION: Gastric volvulus is a rare phenomenon, in which the stomach rotates around the short (mesentero-axial) or longitudinal (organo-axial) axes. Diagnosis of gastric volvulus is challenging due to non-specific presentation and rarity of this clinical condition. The diagnosis of volvulus in patients with altered anatomy is even more challenging, requiring a high index of suspicion, and heavily relies on cross sectional imaging. CONCLUSION: Extensive gastric mobilization is a key step in several foregut and bariatric surgeries, this will leave the stomach with no attachments posteriorly and along the greater curvature and increases the likelihood of volvulus.