Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content +++ 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 ++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] Your Access profile is currently affiliated with '[InstitutionA]' and is in the process of switching affiliations to '[InstitutionB]'. Please click ‘Continue’ to continue the affiliation switch, otherwise click ‘Cancel’ to cancel signing in. Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Password? Forgot Username? Sign in via OpenAthens Sign in via Shibboleth You already have access! Please proceed to your institution's subscription. Create a free a profile for additional features.