Gastric volvulus
| Gastric volvulus | |
|---|---|
| Specialty | Gastroenterology  |
Gastric volvulus or volvulus of stomach a twisting of all or part of the stomach by more than 180 degrees with obstruction of the flow of material through the stomach, variable loss of blood supply and possible tissue death. The twisting can occur around the long axis of the stomach: this is called organoaxial or around the axis perpendicular to this, called mesenteroaxial. Obstruction is more likely in organoaxial twisting than with mesenteroaxial while the latter is more associated with ischemia. About one third of the cases are associated with a hiatus hernia. Treatment is surgical.
The classic triad of gastric volvulus, described by Borchardt in 1904, consists of severe epigastric pain, retching without vomiting, inability to pass a nasogastric tube and sometimes severe pain at the top of left shoulder, this may be due to internal bleeding irritating the diaphragm upon respiration.
Classification
Organoaxial type
In an organoaxial gastric volvulus, the stomach rotates around an axis that connects the gastroesophageal junction and the pylorus. The antrum rotates in opposite direction to the fundus of the stomach.
Mesentericoaxial type
The mesentericoaxial axis bisects the lesser and greater curvatures. The antrum rotates anteriorly and superiorly so that the posterior surface of the stomach lies anteriorly. The rotation is usually incomplete and occurs intermittently. Vascular compromise is uncommon. This etiology comprises approximately 29% of cases of gastric volvulus.
Aetiology
Type 1
Idiopathic gastric volvulus comprises two thirds of cases and is presumably due to abnormal laxity of the gastrosplenic, gastroduodenal, gastrophrenic, and gastrohepatic ligaments.
Type 2
Type 2 gastric volvulus is found in one third of patients and is usually associated with congenital or acquired abnormalities that result in abnormal mobility of the stomach.
Prognosis
The nonoperative mortality rate for gastric volvulus is reportedly as high as 80%.
References
- Schaefer D, Nikoomenesh P, Moore C (1997). "Gastric volvulus: an old disease process with some new twists". Gastroenterologist. 5 (1): 41–5. PMID 9074918.
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