Acute gastric volvulus (GV) is a rare disease with high mortality rate often associated with anatomic abnormalities. Thymoma is the most common neoplasm located in the anterior mediastinum. There is no reported relationship between thymoma and GV. Here we reported a case of thymoma with initial symptom of acute gastric volvulus. A 43-year-old man complained of postprandial abdominal pain, nausea and vomiting. Acute gastric volvulus was diagnosed by chest radiograph, upper digestive tract radiograph and CT scan; later type B3 thymoma was diagnosed by biopsy of mediastinal mass. We inferred that gastric volvulus was secondary to thymoma due to phrenic nerve palsy. The patient was treated with endoscopic de-rotation. Further radiotherapy and chemotherapy were given. During treatments, GV still occurred with less severity and a reduced frequency of approximately every three to four months. We report the first case of thymoma initially presented with acute GV. We suspect a pathological mechanism related to the phrenic nerve palsy. This case indicates that thymoma may present alongside rare acute GV.
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