Gastric volvulus

Definition

• • Gastric volvulus is a twist of the stomach;

Risk factors and assoc. conditions

• • Large hiatal hernia

  • Unusually mobile stomach w/o hiatal hernia.

Pathogenesis

• • Organoaxial volvulus - (more common type) the stomach twists along its long axis (line connecting the cardia and pylorus), and the greater curvature flips up (Fig. C).

  • Mesenteroaxial rotation - the stomach twists around the transverse axis (right angle to the cardiopyloric line) (Fig. A and B).

  • Combined types have also been described.

Presentation

• • If chronic ± aSx → Tx: nonoperative (especially in the elderly)

  • Sx: pain, nausea, unable to vomit; pressure (lung → dyspnea; pericardium → palpitations; esophagus → dysphagia), distention, poor emptying; Sx ↓ w/ vomiting or NG tube;

  • Should be suspected in pts w/ Borchardt triad (acute epigastric pain, violent retching, inability to pass a NG tube)

  • Pts w/ acute severe/progressive Sx → operation

Complications

• • Gastric infarction;

Tx

• • Elective operation usually involves reduction of the stomach and repair of hiatal hernia.

  • Gastropexy alone may be considered for high-risk patients (can be done laparoscopically)