An 81-yo woman with a history of a hiatal hernia and esophagitis on omeprazole presents with 2 days of nausea and retching but is unable to vomit. She denied abdominal pain or constipation. Exam: afebrile, tachycardic, nontender abdomen.
Small bowel obstruction
Barrett's esophagus
Lung abscess
Gastric volvulus
You are correct. CT shows a hiatal hernia that has undergone rotation to cause a gastric volvulus. The 2 chambers in the mediastinum represent the stomach fundus and body. After laparoscopic reduction of her mesentero-axial gastric volvulus, she required ICU support and another gastroscopy to correct bleeding from a duodenal ulcer, and was discharged 2 weeks later.