Abstract: Acute gastric volvulus represents a surgical emergency with a high mortality rate, often complicating giant hiatal hernias. While the clinical "Borchardt’s Triad" provides strong initial suspicion, Multidetector Computed Tomography (MDCT) is essential to guide management. We report the case of a 95-year-old male who presented with classic Borchardt’s triad: epigastric pain, unproductive retching, and the inability to pass a nasogastric tube. Urgent MDCT confirmed an incomplete (<180º) organo-axial volvulus within a massive hiatal hernia. Crucially, the absence of pneumatosis and the preservation of gastric wall enhancement allowed our team to confidently rule out ischemia. Given the patient’s advanced age and radiological signs of gastric viability, a successful conservative approach was adopted. This case emphasizes that MDCT is not merely a diagnostic tool for identifying the "upside-down stomach," but a pivotal risk-stratification instrument that can prevent high-risk emergency surgeries in the elderly.
Hassani et al. (Tue,) studied this question.