BMJ Case Reports 2018; doi:10.1136/bcr-2017-223060
  • Reminder of important clinical lesson

Second-look laparostomy for perforated gangrenous gastric volvulus to prevent total gastrectomy

  1. Ali Warsi1
  1. 1Surgery and Critical care, Furness General Hospital, Barrow-in-Furness, UK
  2. 2Surgery, Gulu Regional Referral Hospital, Gulu, Uganda
  1. Correspondence to Dr Paul K Okeny, okenykpaul{at}
  • Accepted 25 April 2018
  • Published 15 May 2018


A 42-year-old Caucasian woman presented to the emergency department with severe upper abdominal pain and vomiting. Clinically, she was septic, and abdominal examination suggested peritonitis. Following immediate resuscitation, the patient was stabilised and underwent urgent contrast-enhanced CT of the abdomen and pelvis. This revealed a mesenteroaxial gastric volvulus with traction on the mesentery and a small volume of free fluid. She underwent laparotomy revealing gangrenous gastric fundus perforation complicated by persistent intraoperative hypotension. This mandated a damage-control approach for the patient’s safety entailing a limited-sleeve gastrectomy and laparostomy formation. Stabilisation in the intensive care unit allowed for a safer return to the operating room. On second look 24 hours later, previously ischaemic non-viable-looking portions of the stomach had recovered their blood supply. The patient was discharged 31 days postoperatively after recovering from the operations, postoperative wound infections and pleural effusions.


  • Contributors PKO obtained patient consent, collected patient data, designed and wrote the first draft of manuscript. OA participated in collection of data including images and review of manuscript. AW performed the surgery and provided academic review of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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