UNMASKING GASTRIC VOLVULUS IN THE SHADOW OF HYPOTHYROIDISM

A CASE OF ACUTE MESENTERO-AXIAL ROTATION

Abstract

INTRODUCTION

Gastric volvulus is a rare, life-threatening condition caused by an abnormal stomach rotation, potentially leading to obstruction and strangulation. The mesentero-axial type is the most common, comprising about one-third of cases. This report discusses a case of acute mesentero-axial gastric volvulus likely caused by severe hypothyroidism.

CASE

A 77-year-old female with a history of degenerative spine disease, hypertension, hypothyroidism post-thyroidectomy and hyperlipidemia presented with a three-day history of abdominal pain, distension and vomiting. Clinically, her abdomen was distended and tender. Abdominal CT reported mesentero-axial gastric volvulus, and endoscopy showed a distended stomach with undigested food. Barium swallow revealed oesophageal motility disorders but no mass. Further tests showed elevated TSH levels (>51.9 mIU/L) and low free T4 (6.6 pmol/L), indicating severe hypothyroidism, likely due to missed levothyroxine (LT4) doses.

Due to her advanced age and initial presentation of sinus arrhythmia, the plan was to administer LT4 rectally with serial monitoring of TFT. The patient was prescribed a daily dose of 150 mcg (4 mcg/kg/day) of LT4, titrated up to 200 mcg daily (6 mcg/kg/day) and later switched to intravenous LT4 50 mcg daily before undergoing gastropexy. Following thyroid hormone replacement, her condition improved.

CONCLUSION

Severe hypothyroidism can impair gastrointestinal motility, and while gastrointestinal symptoms are common, gastric volvulus is rare. This case emphasises the importance of recognising thyroid dysfunction as a differential cause of gastric volvulus, particularly in patients with thyroid disorders. Early thyroid hormone replacement is essential to prevent recurrence and severe complications.