Acute gastric volvulus is rare but can be fatal if not promptly treated. Simple reduction without correction of the underlying defect(s) can result in later recurrence.
Classification is based on the axis of gastric rotation.
Volvulus
Description
organoaxial
axis from the gastroesophageal junction to the pylorus
mesenterioaxial
axis perpendicular to the organoaxial (through the lesser curvature towards the liver)
mixed
both organoaxial and mesenterioaxial
Risk factors:
(1) laxity in ligaments suspending the stomach
(2) large paraesophageal hiatus
(3) eventration of the diaphragm
Clinical findings:
(1) severe, continuous epigastric pain
(2) retching without vomitus
(3) distention of the upper abdomen
(4) hypotension progressing to shock
Radiographic findings:
(1) 2 distinct fluid levels are seen in the gastric fundus
(2) oral radiocontrast material does not enter the stomach
(3) CT scan shows the 2 regions separated by gastric wall
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