Fact-sheet: Gastric volvulus
Updated on 06/24/2020 at 11:29 AM
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Definition
High mechanical obstructive syndrome due to gastric volvulus.
Occurs in cases of ligamentous laxity (gastrocolic, gastrosplenic, gastrohepatic, gastrophrenic) in elderly patients (female predominance).
In children or infants:
- congenital diaphragmatic anomalies, giant Hiatal hernia
- absence of fixation to the Spleen in cases of asplenia or ectopic Spleen.
Heavy meal: classic predisposing factor
Clinical features
Borchardt's triad:
- severe epigastric and/or left hypochondrial or left hemithoracic pain with dorsal radiation
- unproductive retching
- food intolerance with inability to pass a nasogastric tube
Vague, nonspecific clinical presentation with spontaneously resolving forms
Radiography
Abdominal radiograph of limited value
CT
Demonstration of the volvulus: whirl sign
Allows classification of the volvulus as organoaxial or mesenteroaxial
Signs of severity: spontaneous wall hyperdensity, lack of enhancement after injection, parietal pneumatosis, wall thickening, wall thinning, target sign
Associated Hiatal hernia or diaphragmatic hernia
Asplenia or ectopic Spleen
Management
Surgical emergency:
- reduction of the volvulus
- gastropexy +/- treatment of an associated lesion
Classification
Organoaxial volvulus: rotation around the cardiopyloric axis
Mesenteroaxial volvulus: rotation around the horizontal axis connecting the midpoints of the two gastric curvatures