- Abnormal rotation of the stomach of more than 180 degrees
- Causes closed loop obstruction
- Can result in incarceration and strangulation
- Depending on the axis of rotation is classified as
- Organoaxial
- Mesentericoaxial
- 10% cases occur in children and is usually associated with
diaphragmatic hernia
- Associated with laxity of gastric ligament
Organoaxial volvulus
- Axis of rotation extends from gastro-oesophageal junction and
pylorus
- Antrum rotates in opposite direction to fundus
- Commonest type of volvulus
- Usually associated with diaphragmatic defect
- Strangulation occurs in about 10% cases
Mesentericoaxial volvulus
- Axis of rotation bisects the lesser and greater curves
- Antrum rotates anteriorly and superiorly
- Posterior surface of stomach lies anteriorly
- Rotation is usually incomplete
- Diaphragm is usually intact
- Strangulation is rare
Clinical features
Acute gastric volvulus
- Sudden onset of severe epigastric or left upper quadrant pain
- Of stomach is the thorax then chest pain may occur
- Progressive distension and non-productive retching
- Haematemesis may occur
Borchardt triad
- Epigastric pain
- Retching
- Inability to pass nasogastric tube
Chronic gastric volvulus
- Intermittent epigastric pain and distension
- Early satiety, dyspepsia and dysphagia
- Diagnosis can be difficult
Investigations
- Chest x-ray may show retrocardiac gas-filled viscus
- Plain abdominal x-ray may show distended stomach
- Diagnosis can be confirmed on contrast study or CT scan
Management
- Endoscopic reduction may be attempted in both acute and chronic
cases
- Should not be attempted if clinical suspicion of strangulation
- A PEG can be inserted after reduction to reduce risk of recurrence
- Surgery is often required and involves
- Reduction of the volvulus
- Assessment of viability and resection if required
- Anterior gastropexy to prevent recurrence
- Mortality following surgery for acute gastric volvulus is about 10%
Bibliography
Darani A, Mendoza-Sagaon M, Reinberg O. Gastric
volvulus in children. J Pediatr Surg 2005; 40:
855-858. |