Gastric Volvulus: Diagnosis and Successful Endoscopic De-rotation Towards Conservative Management in a Patient With Multiple Comorbidities.

Gastric volvulus is a condition that is not frequently seen in clinical practice and can present with a myriad of symptoms, meaning it can be challenging to diagnose. We present an 82-year-old female attending the emergency department with epigastric pain and coffee ground vomiting on a background of rectosigmoid cancer and a large, complex hiatus hernia. On investigation there was no drop in haemoglobin. However, the chest X-ray showed air-fluid levels and raised the suspicion of gastric volvulus, particularly given her past medical history. The timely organisation of a computed tomogram (CT) scan allowed for prompt decision-making with involvement of surgical colleagues. The patient proceeded to successful conservative management with upper gastroduodenal endoscopy and a de-rotation technique. This case highlights the importance of considering gastric volvulus as a differential diagnosis in those presenting with epigastric pain and vomiting particularly in patients over 50 with a history of large hiatus hernia. This allows for prompt diagnosis and management and avoidance of major complications like gastric mucosal ischaemia.

Polyserositis secondary to COVID-19: the diagnostic dilemma.

COVID-19 is a novel disease often presenting with a cough, fever or a change in smell or taste. Recently, it has been recognised that COVID-19 may result in multisystemic issues and thus cause atypical symptoms, which can cause diagnostic delay, uncertainty and inaccuracy. A 60-year-old woman presented to the hospital with a 2-day history of mid-thoracic discomfort, intermittent rigours, fevers and general malaise, a few weeks after likely COVID-19 infection. She was admitted and treated for community-acquired pneumonia. However, her symptoms recurred despite multiple courses of antibiotics, which prompted further workup. A combination of a pleural and pericardial effusion was identified, leading to a diagnosis of polyserositis, and a COVID-19 antibody test came back positive. Colchicine was effective at resolving her symptoms, leading to further conviction of a probable postviral polyserositis.

Paraneoplastic cerebellar degeneration secondary to ovarian carcinosarcoma: a cerebellar conundrum.

We present a case of an elderly female patient who presented with a 6-month history of progressive slurred speech, vertigo, unsteadiness and falls. She underwent an extensive battery of neurological and cardiovascular investigations, none of which demonstrated a diagnostic cause for her symptoms. She was referred to the stroke and neurology teams and was started on treatment for presumed anxiety. As her symptoms continued to progress, she was referred to the falls service. Following a multidisciplinary team discussion, she was reviewed by the consultant geriatrician who felt this may be due to a malignancy so the consultant geriatrician arranged blood testsand CT scan of her chest, abdomen and pelvis. These demonstrated a large left adnexal mass and a raised Ca-125 level. The patient was diagnosed with an ovarian tumour, which was treated surgically. A provisional diagnosis of paraneoplastic cerebellar degeneration, secondary to ovarian carcinosarcoma, was made.