Unbounded Medicine

A woman came to the office because of sharp epigastric pain. On physical examination nothing was wrong except of epigastric pain. An endoscopy was performed and reported as normal. An Upper Gastrointestinal Tract Barium Examination was ordered and we found a cascade stomach, which is a rare finding. We exlude other causes of abdominal pain in the first place.

Here are the images.

As you can see in this series, the fundus, still lies in its usual position relative to the structures of the left upper quadrant but the proximal portion of the body of the stomach is in an abnormally anterior and superior position. When this type of stomach is filled with barium (erect position), static roentgenograms may demonstrate a separate fluid level confined to the fundus. At fluonoscopy, barium first fills the dependent, posterior fundus to the highest level of the “ridge” and then spills or “cascades” into the body and antrum.

On the next day we have performed an esophageal manometry and the patients had lower esophageal incompetence, so we performed a laparoscopic Nissen fundoplication with gastropexia.

Now the patient is painless and in excellent condition.

Regards,

Jon Mikel Iñarritu, M.D.