Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with acute onset of severe epigastric pain, persistent retching without emesis (Borchardtโs triad), and progressive abdominal distension. History significant for recent post-prandial fullness, dysphagia, or known hiatal hernia. Symptoms are non-remitting and associated with hemodynamic instability or respiratory distress.
Clinical Examination Findings
Abdominal examination reveals marked epigastric distension and tenderness. Tympany to percussion over the upper abdomen. Bowel sounds may be diminished. Assess for signs of strangulation: peritoneal irritation, guarding, rebound tenderness, and hemodynamic compromise (tachycardia, hypotension).
Treatment Protocol
Immediate surgical consultation required. NPO status, nasogastric tube decompression (if possible), and aggressive fluid resuscitation. Definitive treatment involves emergent surgical detorsion, gastropexy, and repair of underlying anatomical defects (e.g., hiatal hernia repair). Monitor for gastric ischemia or necrosis.