PMC5899864_01
CT of abdomen and pelvis with contrast showing a markedly distended abdomen without focal wall thickening. The J-shaped stomach is rotated along its long axis, displaying a gastric volvulus. Fluid, consistent with blood, is seen tracking along the paracolic gutters and the pelvis.
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An emergent CT scan of the abdomen and pelvis reported a grossly distended stomach with gastric outlet obstruction, as well as a moderate amount of hyperdense intraperitoneal fluid, highly concerning for hemoperitoneum (Figure 3).
Retroflexed endoscopic view of the lesser curvature of the body of the stomach, antrum, and fundus, depicting the deeply J-shape anatomy of the stomach.
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The duodenum was easily accessible and unremarkable (Figure 4).
Repeat CT of abdomen and pelvis with contrast revealing an apparent linear defect measuring 0.9 cm involving the posteroinferior margin of the spleen. Again seen, consistent with prior study is the presence of a moderate amount of hyperdense free intraperitoneal fluid, indicative of hemoperitoneum.
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It revealed the stomach in an anatomically differing position from initial imaging, confirming the presumptive diagnosis, as well as persistent stable hemoperitoneum and a 0.9 cm linear defect involving the posteroinferior margin of the spleen (Figure 5).