Spleen-Preserving Repair of Acute Gastric Volvulus With Wandering Spleen: Anterior Gastropexy and Splenopexy in a 20-Year-Old Man.

Gastric volvulus is an uncommon condition in which the stomach twists on itself, and its association with wandering spleen is attributed to a shared defect of deficient peritoneal fixation. Both conditions are described predominantly in children, and reports of the combination in adults remain rare. When it does occur, the goal of management is often definitive fixation of the affected organs, yet there is limited guidance on the optimal approach in adults, particularly regarding splenic preservation. We present a rare case of gastric volvulus with wandering spleen in a 20-year-old man, managed with robot-assisted anterior gastropexy and splenopexy. A 20-year-old man with autism and a reported chromosome 22 abnormality, described as a partial deletion with partial trisomy 22, presented with abdominal pain, distension, nausea, and nonbloody emesis. Family history was notable for a brother who died at age 13 from bowel ischemia secondary to volvulus. Computed tomography (CT) revealed extreme gastric distension with a wandering spleen located in the right upper quadrant. An upper gastrointestinal contrast study confirmed gastric volvulus at the pyloric channel. After nasogastric decompression with 3 L of output, the patient was taken to the operating room on hospital day two. Endoscopic reduction was unsuccessful, and robot-assisted reduction, anterior gastropexy, and splenopexy were performed. The spleen was viable and nonischemic at exploration, and fixation was chosen to preserve splenic function. The patient had an uncomplicated postoperative course and was discharged on postoperative day two.  Gastric volvulus with wandering spleen can present in young adults and should be considered when cross-sectional imaging demonstrates acute gastric obstruction with an ectopic spleen. Robot-assisted gastropexy and splenopexy addressed the underlying fixation defect while preserving splenic function. In this patient, communication difficulties related to autism complicated symptom assessment. Decisions to pursue advanced imaging should be guided by the clinical presentation and the degree of suspicion for volvulus rather than by any single patient characteristic.