Mesenteroaxial gastric volvulus associated with a wandering spleen in an older woman treated with anterior gastropexy and splenectomy: a case report.

Abstract

An 80-year-old woman with Parkinson disease presented with sudden abdominal pain, back pain, and vomiting during a meal. Computed tomography revealed marked gastric dilatation with cranial displacement and rotation of the antrum, consistent with mesenteroaxial gastric volvulus. This was accompanied by an ectopic spleen adjacent to the greater curvature and suspected pedicle torsion, consistent with a wandering spleen. Nasogastric tube passage was initially unsuccessful. Emergency upper gastrointestinal endoscopy achieved gastric decompression and transient detorsion; however, immediate retorsion was observed, and continuous decompression was maintained after successful tube placement. Definitive surgery was performed on hospital day 2. The stomach was reduced and fixed to the abdominal wall via anterior gastropexy; splenectomy was performed due to marked splenic mobility and concerns about recurrent torsion. Histopathological examination revealed congestion and partial hemorrhagic infarction compatible with splenic torsion. The postoperative course was uneventful; the patient was discharged on postoperative day 14 without recurrence during the follow-up. This case underscores that immediate retorsion after endoscopic reduction might warrant prompt definitive surgery with gastropexy and management of a wandering spleen should be individualized according to mobility and splenic viability.