P0448 - Incomplete Gastric Obstructive Torsion Representing Esophagogastric Outflow Obstruction Reduced by Endoscopy

Rehan Razzaq, DO¹, Mahum Nadeem, MBBS², Shreesh shrestha, MD², Asiya Tafader, MBBS², Joseph S.. Spataro, MD^3
1Virginia Commonwealth University, Richmond, VA; ²Virginia Commonwealth University, Henrico, VA; ³Hunter Holmes Mcguire VA, Richmond, VA

Introduction: Gastric torsion is an abnormal rotation of the stomach around a vertical or horizontal axis due to laxity of the fixation ligaments (ie phrenoesophageal ligament). We describe a case of reversible incomplete gastric obstruction torsion successfully treated with endoscopic intervention.

Case Description/Methods: A 55-year-old male presents with six months of intermittent liquid and solid food dysphagia. He had episodes of entirely normal swallowing for liquids and solids. During an episode of dysphagia, an esophagram (Figure A) revealed esophageal outflow obstruction. Subsequent upper endoscopy revealed food and fluid in the esophagus with spiraled folds obstructing the esophagogastric outlet (Figure D) requiring torque to intubate the stomach. Upon retroflexion, the gastric rugae presented a spiraled appearance “torsion” (Figure B). The proximal extent of the fundus could not be visualized. After manipulation with appropriate torque and insufflation, the torsion was reduced (Figure C, and E) and the endoscope could easily be passed from the esophagus to stomach. This observation was consistent with reduction of the torsion. A nasogastric tube was placed and thoracic surgery performed an anterior gastropexy with placement percutaneous endoscopic gastrostomy tube. On recent follow up the patient has remained asymptomatic.

Discussion: Gastric torsion may be idiopathic or after inappropriate endoscopic or laparoscopic hiatal hernia repair (i.e., with wraps) when the vertical axis is not adhered to. This also spontaneously occurs with phrenoesophageal ligament laxity that can be reduced in endoscopy.

Nature abhors curves in the stomach. Careful observation of the cardioesophageal junction is important for excluding tumors and anatomic abnormalities. Endoscopists should observe for inappropriate spiraling of gastric mucosa. We encourage everyone to spend time interrogating this important area.



Disclosures:


Rehan Razzaq, DO¹, Mahum Nadeem, MBBS², Shreesh shrestha, MD², Asiya Tafader, MBBS², Joseph S.. Spataro, MD³. P0448 - Incomplete Gastric Obstructive Torsion Representing Esophagogastric Outflow Obstruction Reduced by Endoscopy, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.