Gastric Volvulus

Acute

• • Severe abdominal pain

  • Vomiting followed by retching and then inability to vomit

  • Epigastric distention

  • Inability to pass an NG tube

Chronic

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

Epidemiology

• • 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

Symptoms and Signs

Acute

• • Severe abdominal pain

  • Vomiting followed by retching and then inability to vomit

  • Epigastric distention

  • Inability to pass an NG tube

Chronic

• • May be asymptomatic or cause crampy intermittent abdominal pain

Imaging Findings

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

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

Rule Out

• • Other causes of upper GI obstruction

• • Symptoms and signs consistent with gastric volvulus

  • Upper GI contrast radiography will provide diagnosis

When to Admit

• • All cases of acute volvulus

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

• • Immediate laparotomy for acute cases

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

Surgery

Indications

• • All cases of gastric volvulus

Complications

• • Gastric ischemia

  • Gastric necrosis

  • Gastric perforation

  • Shock

Prognosis

• • Good outcome if diagnosed and treated promptly

  • The mortality rate is high with gastric ischemia and necrosis

References