Primary gastric volvulus: a report of two cases

Abstract

Gastric volvulus is an uncommon cause of gastric obstruction. It can be classified as primary when no underlying condition is identified as the cause for the rotation. An acute presentation includes typical symptoms and is frequently detected by imaging studies. Chronic cases present with intermittent vague symptoms and imaging studies may be normal during the symptomatic interval. The lack of specific symptoms and signs delays the diagnosis of chronic volvulus. However, appropriate treatment demands prompt diagnosis. We report two cases of primary gastric volvulus, with chronic or subacute symptoms and normal imaging studies during the asymptomatic periods. Both were treated surgically and had an uneventful follow-up.

A surprising finding during solid‐phase gastric emptying scintigraphy

“…Diagnosis of the nonacute types can be delayed for many years due to the nonspecific and intermittent clinical picture and absence of definite diagnostic tools. 11 , 12 Biological tests are mostly almost or completely normal, as well as gastroscopy out of the acute phase. Rarely, gastroscopy demonstrates a twist at the entrance of the stomach, or difficulties to pass through the pylorus.…”

First Described Case of Gastric Volvulus Following Open Cholecystectomy

“…The severity of presentation is variable depending on both the degree of rotation, as well as the acuity of the volvulus. Associated with up to 70% of diagnosed volvulus is the Brochardt's triad, which is defined as pain, retching, and inability to pass a nasogastric tube [3]. With chronic volvulus, there is a risk for bleeding from gastric ulceration development leading to anemia.…”

“…An organoaxial volvulus occurs when the rotation occurs along the axis connecting the stomach cardia and pylorus; whereas mesenteroaxial volvulus occurs when rotation occurs perpendicular to the long axis of the stomach, connecting the greater and lesser curvatures [2]. It can also be classified as primary or secondary: primary when the cause of rotation is attributed to the laxity of the stomach's ligamentous attachments, and secondary when there are attributable conditions such as hernias, connective tissue disorders, adhesions, or abdominal wall defects [3]. Clinical presentations vary and are often nonspecific with vomiting and epigastric pain being most common.…”

A Case of Gastric Volvulus in the Emergency Department

“…The term volvulus derives from the Latin volvere, to turn or roll [4]. Volvulus is characterized as a rotation of the stomach greater than 180° [5], and symptoms vary based on degree of rotation and speed of onset. Borchardt's classic triad of symptoms is seen in up to 70% of cases [1].…”

“…Current mortality figures indicate there is a 15-20% mortality rate from acute gastric volvulus. There have been nonoperative rates as high as 80% reported in the past [5].…”