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Acute

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  • • Severe abdominal pain

    • Vomiting followed by retching and then inability to vomit

    • Epigastric distention

    • Inability to pass an NG tube

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Chronic

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  • • May be asymptomatic or associated with intermittent crampy abdominal pain

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Epidemiology

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  • • Chronic volvulus is more common than acute

    • The stomach may rotate about its longitudinal axis (organo-axial volvulus) or a line drawn from the mid lesser to the mid greater curvature (mesenterioaxial volvulus)

    • Organo-axial volvulus is more common than mesenterioaxial volvulus and is often associated with a paraesophageal hiatal hernia

    • Volvulus may also be caused by eventration of the left diaphragm, allowing the colon to rise and twist the stomach by pulling on the gastrocolic ligament

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Symptoms and Signs

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Acute

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  • • Severe abdominal pain

    • Vomiting followed by retching and then inability to vomit

    • Epigastric distention

    • Inability to pass an NG tube

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Chronic

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  • • May be asymptomatic or cause crampy intermittent abdominal pain

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Imaging Findings

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  • • Upper GI contrast radiography will show a block at the point of the volvulus

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  • • A high level of suspicion is required for timely diagnosis of acute gastric volvulus to avoid complication of gastric ischemia and necrosis

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Rule Out

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  • • Other causes of upper GI obstruction

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  • • Symptoms and signs consistent with gastric volvulus

    • Upper GI contrast radiography will provide diagnosis

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When to Admit

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  • • All cases of acute volvulus

    • Cases of chronic volvulus if severely symptomatic or evidence of possible gastric ischemia and shock

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  • • Immediate laparotomy for acute cases

    • Cases associated with paraesophageal hiatal hernia should be treated by repair of the hernia and anterior gastropexy

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Surgery

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Indications

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  • • All cases of gastric volvulus

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Complications

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  • • Gastric ischemia

    • Gastric necrosis

    • Gastric perforation

    • Shock

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Prognosis

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  • • Good outcome if diagnosed and treated promptly

    • The mortality rate is high with gastric ischemia and necrosis

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References

Schaefer DC et al. Gastric volvulus: an old disease process with some new twists. Gastroenterologist. 1997;5:41.  [PubMed: 9074918]
Wasselle JA, Norman J. Acute gastric volvulus: pathogenesis, diagnosis, and treatment. Am J Gastroenterol. 1993;88:1780.  [PubMed: 8213725]

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