Role of imaging in gastric volvulus: Stepwise approach in three cases

Larssen, Kristian Stritesky; Štimec, Bojan; Takvam, Jon Anders; Ignjatović, Dejan

doi:10.4318/tjg.2012.0418

Cited by 8 publications

(7 citation statements)

References 11 publications

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“…CT scan with oral contrast and 3D reconstruction has been increasingly utilized for the diagnosis and also assist in surgical planning. 18 19 Esophagogastroduodenoscopy can reveal a twisted stomach along with mucosal edema, rules out gastric necrosis, and can also be utilized for endoscopic decompression as a temporizing measure.…”

Section: Discussionmentioning

confidence: 99%

Management and Outcomes in Gastric Volvulus: A Tiered Approach

Askari

Tezcan

Patel

et al. 2022

Digestive Disease Interventions

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Introduction Gastric volvulus is a rare yet life-threatening condition requiring urgent attention. In this case series and literature review, we present the difficulties in management and outcome in patients with gastric volvulus and suggest a tiered framework to guide management. All consecutive cases at a single institution presenting between January 1, 2010, and June 30, 2020, were included. Chi-squared analyses were undertaken to compare outcomes across different groups. A total of 48 patients presented with gastric volvulus; the median age was 78 years (interquartile range [IQR]: 69–84) and 70.8% were female. Most patients had an ASA score of III (n = 19/48, 39.6%) or IV (n = 14/48, 29.2%). In total, 62.5% (n = 30/48) underwent laparoscopic surgery and mesh was used in 40.0%. Eighteen patients (37.5%) were not suitable candidates for surgery or declined surgery. The median length of stay in those undergoing surgery was 4 days (IQR: 2–6). The complication rate in this cohort was 26.7% (n = 8/30). Of these eight patients, four had postoperative nausea, and four others suffered from pneumothorax, wound hematoma, intra-abdominal bleeding, or intra-abdominal collection. The patient who had a serious intra-abdominal bleed returned to operating room and required blood transfusions on day 1 postsurgery. The readmission rate in the surgery group was 6.6% (n = 2/30), both of who had prolonged nausea and were treated symptomatically. The overall 30-day morality in the surgical group was 3.3%. Over a follow-up period of 37 months, 10.0% had a recurrence of hernia, all of who were managed conservatively. Gastric volvulus is a surgical emergency that is associated with a high rate of morbidity and mortality. A tiered treatment algorithm based on urgency can help deliver timely treatment and standardize care. One in 10 patients post–gastric volvulus repair will have recurrence of para-oesophageal hernia but can be treated conservatively.

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Section: Discussionmentioning

confidence: 99%

Management and Outcomes in Gastric Volvulus: A Tiered Approach

Askari

Tezcan

Patel

et al. 2022

Digestive Disease Interventions

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“…CT is not only the first study performed in many patients with gastric volvulus but also the preferred modality for evaluation of complications such as ischemia and perforation, which are reported in 5–28% of cases with a mortality rate up to 50%, emphasizing the importance of early diagnosis and treatment [14, 15]. In our series, perigastric fluid and presence of a pleural effusion were significantly more frequent in patients with ischemia at surgical pathology, underscoring the need to observe these findings on CT when gastric volvulus is suspected.…”

Section: Discussionmentioning

confidence: 99%

CT of Gastric Volvulus: Interobserver Reliability, Radiologists' Accuracy, and Imaging Findings

Mazaheri

Ballard

Neal

et al. 2019

American Journal of Roentgenology

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OBJECTIVE. The objective of this study was to identify CT findings and determine interobserver reliability of surgically proven gastric volvulus. MATERIALS AND METHODS. This single-center retrospective study included 30 patients (21 women, nine men; mean age, 73 years old) with surgically proven gastric volvulus who underwent preoperative CT and 31 age- and sex-matched control subjects (21 women, nine men; mean age, 74 years old) with large hiatal hernias who were imaged for reasons other than abdominal pain. Two blinded radiologists reviewed the CT images and recorded findings of organoaxial and mesenteroaxial gastric volvulus and ischemia. Interobserver reliability, reader accuracy, sensitivity, specificity, and likelihood ratios of each CT finding were calculated. RESULTS. The radiologists were overall 90% accurate (55/61; six false-negatives per reader) in identifying gastric volvulus. Interobserver agreement was substantial (κ = 0.71) for identifying the presence or absence of gastric volvulus. Agreement for most CT findings of gastric volvulus (11/14, 79%) was excellent (5/14, 36%) or substantial (6/14, 43%); the remaining findings showed moderate agreement (3/14, 21%). The most frequent and sensitive CT findings of volvulus with high positive likelihood ratios were stenosis at the hernia neck (reader 1, sensitivity = 80%, positive likelihood ratio = 26.66; reader 2, sensitivity = 77%, positive likelihood ratio = 12.83) and transition point at the pylorus (reader 1, sensitivity = 80%, positive likelihood ratio = 17; reader 2, sensitivity = 70%, positive likelihood ratio = 15). The presence of perigastric fluid or a pleural effusion were significantly more frequent in patients with ischemia at surgical pathology (p < 0.05 in all comparisons, both radiologists). CONCLUSION. In our series, CT showed substantial interobserver agreement and fair accuracy in identifying the presence of gastric volvulus.

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“…However, patients presenting acute abdomen frequently undergo a CT scan. The use of abdominal CT in these cases, especially in GV, can lead to the immediate diagnosis with all the anatomical details, and offer extra-luminal information, such as the presence of life-threatening visceral ischemia, placing the CT scan in a position of undoubted advantage over other imaging methods for this diagnosis 17 - 19…”

Section: Discussionmentioning

confidence: 99%

Intrathoracic gastric volvulus: an autopsy case report

Ferreira

Maximiano

Santos

et al. 2013

ACR

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First described by Berti in 1866 , gastric volvulus (GV) is an uncommon and potentially lethal entity. GV occurs when the stomach twists by more than 180º resulting in obstruction of the alimentary tract, visceral ischemia, necrosis, and perforation. It is classified according to the rotation axis in organoaxial, mesenteroaxial or a combination of both. The clinical presentation can be acute, and is usually severe or chronic, which sometimes may be asymptomatic. It predominantly occurs in the fifth decade of life, but children, mainly those under the age of 1 year, may be affected. No ethnicity or gender was observed to show predominance. This entity is related to gastric, diaphragmatic disorders as well as laxity of gastric ligaments. Acute GV may complicate with incarceration and strangulation of the stomach when gastric necrosis ensues. These cases show a mortality rate of 60%. The authors report the fatal case of a surgically treated GV in a 43-year-old female patient who looked for medical care only after 1 month of initial symptoms. Diagnosis was confirmed with a thoracic and abdominal axial computed tomography. Besides the entire stomach being herniated and twisted into the thoracic cavity, the pancreas was pulled up through the hiatal orifice, provoking acute pancreatitis. Because of gastric necrosis and perforation, gastroenteric fluid drained into the mediastinum and left pleural space. The postoperative outcome was unfavorable resulting in the patient’s death. The authors call attention to the severeness of the disease, and therefore the need of precocity of diagnosis and surgical treatment.

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Role of imaging in gastric volvulus: Stepwise approach in three cases

Cited by 8 publications

References 11 publications

Management and Outcomes in Gastric Volvulus: A Tiered Approach

Management and Outcomes in Gastric Volvulus: A Tiered Approach

CT of Gastric Volvulus: Interobserver Reliability, Radiologists' Accuracy, and Imaging Findings

Intrathoracic gastric volvulus: an autopsy case report

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