A review article on gastric volvulus: A challenge to diagnosis and management

Abstract

Acute gastric volvulus is a life-threatening condition, but its intermittent nature and vague symptoms may make diagnosis difficult. Imaging is usually only diagnostic if carried out when patients are symptomatic. The population affected ranges from paediatric age group to elderly with multiple co-morbidities. Laparoscopic repair is advisable once a diagnosis is reached. This review on gastric volvulus focuses on the diagnostic and management challenges encountered, together with strategies for dealing with them. Lessons have emerged which may assist in dealing with such a rare presentation in future.

Bowel in Chest: Type IV Hiatal Hernia

“…4 Their natural course can become complicated by volvulus, incarceration, perforation, or even recurrent pneumonia due to dysphagia and frequent vomiting with aspiration. 5 As with our patient, incarceration or strangulation of the stomach and/or bowels may present as a life threating complication. 5 If the large hiatal hernia is detected early in the course of the natural evolution, elective surgical repair is recommended, because emergent surgery has been associated with acute organ failure with poor outcomes and a reported mortality rate of up to 56% in some series.…”

Abdominal pain with a twist: a rare presentation of acute gastric volvulus

“…The stomach is normally fixed to the abdominal wall via gastro-phrenic ligament, gastro-splenic ligament, gastro-colic ligament, and gastro-hepatic ligament along with being firmly held proximally at the cardia and distally at retroperitoneum fixation in duodenum [5,6]. Gastric volvulus can be either primary or secondary, with primary gastric volvulus occurring in 30% of patients when the ligaments are either lax, atrophic, or rupture.…”

“…The second type is mesenteroaxial where twisting occurs along a transverse gastric axis. A combination of both is the rarest form [5,6]. Gastric volvulus can present either as an acute or chronic presentation, classical triad is present in 70% of the cases presenting as severe epigastric abdominal pain and distension, vomiting followed by non-productive retching, and inability to pass NG tube [1-3].…”

“…Due to its rarity, the exact incidence remains unknown. It was first described by Berti in 1866 in a 60-year-old man on autopsy and the first surgery for this condition was performed in 1897 by Berg [5–7]. Early recognition and treatment are essential as they may lead to reversal of symptoms and improved prognosis.…”

Boerhaave's syndrome secondary to gastric volvulus

“…La complicación más grave es la volvulación gástrica. Se clasifica en tres tipos en función de su eje de volvulación [6][7][8] : mesenteroaxial (la rotación ocurre alrededor del eje transversal del cuerpo gástrico, perpendicular a la línea que va del cardias al pílo-ro, que ocurre en el 29% de los casos, y que presenta más riesgo de volvulación gástrica asociada a necrosis gástrica y esofágica), organoaxial (la rotación ocurre alrededor del eje cardiopilórico del estómago, 59% de frecuencia) o mixto (12%).…”