The medical mystery in the March 6 issue1 involved an 82-year-old woman who presented with respiratory symptoms and then, 6 years later, presented with epigastric pain, nausea, and vomiting. During her first visit, an intrathoracic stomach and an asymptomatic partial gastric volvulus (Panel A, arrows) were diagnosed. The patient refused any intervention at that time. She remained asymptomatic until she presented with the epigastric pain, nausea, and vomiting. An upper endoscopic study showed twisting of gastric folds, and the endoscope could not be advanced beyond 5 cm from the gastroesophageal junction. A barium study (Panel B) and a computed tomographic scan of the chest and abdomen (Panel C) showed an organoaxial gastric volvulus and an intrathoracic stomach (arrows). The patient continued to refuse surgical intervention, but her symptoms resolved without treatment. At a follow-up visit 12 months later, she remained free of symptoms.
NEJM Volume 358:1968-1969 May 1, 2008 Number 18
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