Gastric volvulus in an elderly male with a hiatal hernia and a wandering spleen: a case report

Gastric volvulus is a rare surgical emergency that can lead to obstruction, ischemia, and necrosis if not promptly managed. We report a unique case of a 78-year-old male who presented during the 2024 Islamic pilgrimage season with symptoms of epigastric pain and persistent vomiting. Imaging revealed a mesenteroaxial gastric volvulus associated with a large hiatal hernia and a wandering spleen—an uncommon triad, especially in adults. The patient underwent successful laparoscopic reduction of the volvulus, cruroplasty, Toupet fundoplication, and anterior gastropexy. Postoperative recovery was uneventful, and the patient was discharged in good condition. This case highlights the importance of high clinical suspicion, appropriate imaging, and timely surgical intervention in managing gastric volvulus. It also underscores the need to identify and address contributing anatomical abnormalities to prevent recurrence. To our knowledge, this is the first reported adult case of concurrent gastric volvulus, hiatal hernia, and wandering spleen.