Secondary Mesenteroaxial Gastric Volvulus in an Elderly Female: A Rare Presentation of an Occult Diaphragmatic Hernia

Gastric volvulus is a surgical emergency characterized by rotation of the stomach greater than 180°, potentially leading to ischemia and perforation. Mesenteroaxial volvulus associated with a late-presenting diaphragmatic hernia in adults is an uncommon clinical entity. A 70-year-old woman with diabetes presented with acute abdominal distension and lactic acidosis. Nasogastric decompression yielded 3 L of coffee-ground aspirate, and computed tomography (CT) identified a mesenteroaxial gastric volvulus. Emergency laparotomy revealed a left-sided diaphragmatic hernia containing the gastric antrum and pylorus. Management included detorsion, reinforcement of a focal ischemic area on the posterior gastric wall, diaphragmatic repair, and gastropexy. This case highlights the silent nature of congenital diaphragmatic defects in the elderly, which can present as life-threatening acute scenarios. It emphasizes the importance of immediate and adequate resuscitative measures, coupled with early diagnosis and definitive treatment.