Acute gastric volvulus: case report and review of the literature

Abstract

Gastric volvulus is a rare but potentially life-threatening cause of upper gastrointestinal obstruction. Emergency physicians must maintain a high index of suspicion in patients who present with signs and symptoms suggesting foregut occlusion. We report an illustrative case and review the pathogenesis, classification, diagnosis and treatment of this rare entity.

Acute mesenteroaxial gastric volvulus on computed tomography

“…[1,4,5] Gastric volvulus can be classified based on axis of rotation, severity (acute or chronic), extent (total or partial) or aetiology (primary or idiopathic). [6] The most frequently used classification system describes 3 types of gastric volvulus: organoaxial, mesenteroaxial and combination-unclassified. [5,6] This is based on the axis of rotation.…”

“…[6] The most frequently used classification system describes 3 types of gastric volvulus: organoaxial, mesenteroaxial and combination-unclassified. [5,6] This is based on the axis of rotation. Organoaxial is the most common variant, accounting for approximately two-thirds of cases, and occurs when the stomach rotates along its long axis (Fig.…”

“…4). [1,6] The greater curvature is displaced superiorly, and the lesser curvature lies more caudally in the abdomen. If the twist is >180 o , gastric outlet obstruction occurs.…”

“…[7] One of the predisposing factors for volvulus is the presence of a diaphragmatic defect; in adults, organoaxial volvulus occurs commonly in the setting of a post-traumatic diaphragmatic defect or a para-oesophageal hernia. [1,6] Another predisposing factor for volvulus is the presence of an abnormality relating to the anchoring of the stomach and the surrounding ligaments. [6] This is thought to be one predisposing factor in the development of the second type of volvulus, and the variant encountered in our patient -mesenteroaxial volvulus.…”

“…[1,6] Another predisposing factor for volvulus is the presence of an abnormality relating to the anchoring of the stomach and the surrounding ligaments. [6] This is thought to be one predisposing factor in the development of the second type of volvulus, and the variant encountered in our patient -mesenteroaxial volvulus. The gastrohepatic ligament is demonstrated on the coronal and axial images (Fig.…”