Gastric volvulus
Updates to Article Attributes
Body
was changed:
Gastric volvulus is a specific type of volvulus that occurs when the stomach twists on its mesentery. It can range from asymptomaticshould be at least 180 and causes bowel obstruction to a potentially catastrophic conditionbe called gastric volvulus and merely gastric rotation on its root is not considered gastric volvulus.
Clinical presentation
Patients may present with the classic triad of Borchardt, which is
- severe sudden epigastric pain
- intractable retching without vomiting
- inability to pass a nasogastric tube
Chronic symptoms are more common in patients with mesentero-axial volvulus.
Pathology
Subtypes
Both subtypes are surgical emergencies and warrant treatment
Organo-axial volvulus
- more common of the two types in adults (2/3 of cases)
- commonly occurs in the setting of trauma or para-oesophageal hernia
- stomach is rotated along its long axis (along the cardiopyloric line, which is drawn between the cardia and the pylorus)
- mirror image of normal anatomy can occur with reversal of the greater and lesser curves
- antrum rotates anterosuperiorly
- fundus rotates posteroinferiorly
- complete (>180º) present with obstruction or ischemia
- incomplete rotation (<180º) also called organo-axial position of the stomach, usually asymptomatic
complete (>180º) present with obstruction or ischemia
Mesentero-axial volvulus
- less common in adults, but is more common than organo-axial volvulus in the paediatric population (59% of gastric volvulus
- rotation around short axis from the lesser to greater curvature (i.e. perpendicular to the cardiopyloric line)
- usually incomplete, <180°
- displacement of antrum above gastro-oesophageal junction; stomach appears upside-down with the antrum and pylorus superior to the fundus and proximal body
- coincides with the axis of mesenteric attachment and is associated with severe obstruction and strangulation
- less associated with diaphragmatic defect
- plain films may show an intrathoracic stomach with two air fluid levels 1
Associations
-<p><strong>Gastric volvulus</strong> is a specific type of <a href="/articles/volvulus">volvulus</a> that occurs when the stomach twists on its <a href="/articles/mesentery">mesentery</a>. It can range from asymptomatic to a potentially catastrophic condition.</p><h4>Clinical presentation</h4><p>Patients may present with the classic triad of Borchardt, which is</p><ul>- +<p><strong>Gastric volvulus</strong> is a specific type of <a href="/articles/volvulus">volvulus</a> that occurs when the stomach twists on its <a href="/articles/mesentery">mesentery</a>. It should be at least 180 and causes bowel obstruction to be called gastric volvulus and merely gastric rotation on its root is not considered gastric volvulus.</p><h4>Clinical presentation</h4><p>Patients may present with the classic triad of Borchardt, which is</p><ul>
-<li>incomplete (<180º) also called organo-axial position of the stomach, usually asymptomatic</li>- +<li>incomplete rotation (<180º) also called organo-axial position of the stomach, usually asymptomatic</li>
References changed:
- 8. Guniganti P, Bradenham CH, Raptis C et-al. CT of Gastric Emergencies. Radiographics. 2015;35 (7): 1909-21. <a href="http://dx.doi.org/10.1148/rg.2015150062">doi:10.1148/rg.2015150062</a> - <a href="http://www.ncbi.nlm.nih.gov/pubmed/26562229">Pubmed citation</a><span class="auto"></span>
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