Acute gastric volvulus combined with pneumatosis coli rupture misdiagnosed as gastric volvulus with perforation: A case report

Figure 1 Abdominal computed tomography scan upon admission. A: Free intraperitoneal air without fluid collection (purple arrow) and a markedly dilated gastric lumen with fluid collection (blue arrow); B: The lower gastric margin reaching the level of the anterior superior iliac spine (yellow arrow); C: Spleen displacement to the upper pancreatic margin (orange arrow) and free intraperitoneal air (purple arrow); D: The gastric tube entering the gastric body from left to right through the posterior aspect of the stomach (green arrow).

Figure 2 Gastroscopic examination upon admission. A: Shows distortion of the gastric wall and deformation of the gastric lumen (blue arrows); B: Shows multiple scattered superficial ulcers in the gastric body (purple arrows).

Figure 3 Upper gastrointestinal imaging examination upon admission. A: Shows the anterior view of upper gastrointestinal radiography, the contrast agent is limited, and the gastric lumen is not completely visualized; B: The posterior view of upper gastrointestinal radiography, the gastric lumen is dilated with pneumatosis, and the greater and lesser curvature sides cannot be distinguished.

Figure 4 Reexamination via gastroscopy. A: Shows that the mucosa of the gastric wall is flat after reduction, and the antrum and pylorus can be observed (blue arrows); B: Shows that the duodenum is morphologically normal (white arrows).

Figure 5 Abdominal enhanced computed tomography examination. A: Shows the disappearance of free air in the abdominal cavity (purple arrows), improvement of gastric dilatation, normal gastric morphology (blue arrows), and return of the spleen to a normal anatomical position (orange arrows); B: Shows no thickened mass in the gastric wall (blue arrows) and normal pancreatic morphology (green arrows); C-F: Multiple cases of subserosal pneumatosis in the colon (orange arrows) with intact continuity of the bowel wall (white arrows).