Presentation
Sudden onset of abdominal distension and vomiting.
Patient Data
The stomach is enlarged and filled with food and gas. The pylorus is displaced dorsally and is gas filled on the right lateral projection, indicating gastric malposition. The pyloric displacement is confirmed on the ventrodorsal projection, and is positioned to the left of midline. The duodenum is mildly gas filled and can be traced to the pylorus. There is compartmentalization with a typical shelf of tissue between the fundus and pylorus. The stomach is causing a mass effect and displacing the small intestine caudally. There is mild gas filling of the small intestine.
There is increased soft tissue opacity of the peritoneal fat ventral to the stomach and spleen.
Gastric dilation and volvulus. Peritoneal effusion may be blood, exudate, or gastric contents.
Case Discussion
The key to diagnosing the gastric malposition is to identify the pylorus and fundus and determine their relative positions compared to normal. Gas filling of the pylorus and the duodenum can be helpful in identifying this portion of the stomach.
The effusion indicates complications in this case, and the concern is gastric rupture. At surgery there was hemoabdomen with rupture of the short gastric arteries and necrosis of the stomach wall without perforation.
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