CASE DESCRIPTION A 5-year-old girl presented to a hospital at night with intermittent vomiting and abdominal pain since the morning. She was exhausted and unable to drink or eat properly but had a normal bowel movement that day. The physician performed abdominal X-ray imaging, which revealed abnormal gas distribution (Fig. 1-a,b). However, her symptoms remained stable. Thus, she was diagnosed with early gastroenteritis, and the physician decided to discharge her. But she was transferred to our hospital the next day with worsening symptoms. She had a history of undergoing surgery for a congenital diaphragmatic hernia at birth. Her physical examination indicated a distended abdomen with periumbilical tenderness on palpation. Furthermore, abdominal X-ray revealed the absence of gas (Fig. 1-c,d), and contrast-enhanced abdominal computed tomography scan revealed an enlarged stomach with rotation and a right-sided spleen (Fig. 2). An indwelling nasogastric tube was successfully inserted under fluoroscopy, and the symptoms of the patient dramatically improved after removing >1 liter of gastric contents. Finally, she was diagnosed with acute gastric volvulus and a wandering spleen.
