Gastric volvulus
Updates to Article Attributes
Body
was changed:
A gastric volvulus is a specific type of volvulus that occurs when the stomach twists on its mesentery. It can range from asymptomatic to a potentially catastrophic condition.
Clinical presentation
Patients may present with the classic triad of Borchardt which consists of:
- severe sudden epigastric pain
- intractable retching without vomiting
- inability to pass a NG tube
Chronic symptoms are more common in patients with mesentero-axial volvulus.
Pathology
Sub types
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
paraesophagealpara-oesophageal hernia - stomach is rotated along its long axis (along a line from the cardia to pylorus)
- mirror image of normal anatomy can occur with reversal of the greater and lesser curves
- antrum rotates anterosuperiorly
- fundus rotates posteroinferiorly
- incomplete (less than 180') also called organo-axial position of the stomach, usually asymptomatic
- complete (more than 180') present with obstruction or ischemia
Mesentero-axial volvulus
- less common in adults, but is more common than an organo-axial volvulus in the paediatric population (59% of gastric volvulus).
- rotation around short axis from the lesser to greater curvature (usually incomplete, less than 180°).
- displacement of antrum above GEJ; 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 intra-thoracic stomach with two air fluid levels 1.
Associations
-<p>A <strong>gastric volvulus</strong> is a specific type of <a style="color: rgb(63, 117, 216); text-decoration: none;" href="/articles/volvulus">volvulus</a> that occurs when the stomach twists on its <a style="color: rgb(63, 117, 216); text-decoration: none;" 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 consists of:</p><ul>-<li>severe sudden epigastric pain</li>-<li>intractable retching without vomiting</li>-<li>inability to pass a NG tube</li>-</ul><p>Chronic symptoms are more common in patients with mesentero-axial volvulus.</p><h4>Pathology</h4><h5>Sub types</h5><p>Both subtypes are surgical emergencies and warrant treatment</p><h6>-<strong>Organo-axial volvulus</strong> </h6><ul>-<li>more common of the two types in adults (2/3 of cases)</li>-<li>commonly occurs in the setting of trauma or paraesophageal hernia</li>-<li>stomach is rotated along its long axis (along a line from the cardia to pylorus)</li>- +<p>A <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 consists of:</p><ul>
- +<li>severe sudden epigastric pain</li>
- +<li>intractable retching without vomiting</li>
- +<li>inability to pass a NG tube</li>
- +</ul><p>Chronic symptoms are more common in patients with mesentero-axial volvulus.</p><h4>Pathology</h4><h5>Sub types</h5><p>Both subtypes are surgical emergencies and warrant treatment</p><h5>Organo-axial volvulus </h5><ul>
- +<li>more common of the two types in adults (2/3 of cases)</li>
- +<li>commonly occurs in the setting of trauma or para-oesophageal hernia</li>
- +<li>stomach is rotated along its long axis (along a line from the cardia to pylorus)</li>
-<li>antrum rotates anterosuperiorly</li>-<li>fundus rotates posteroinferiorly</li>- +<li>antrum rotates anterosuperiorly</li>
- +<li>fundus rotates posteroinferiorly</li>
-</li>-<li>incomplete (less than 180') also called organo-axial position of the stomach, usually asymptomatic</li>-<li>complete (more than 180') present with obstruction or ischemia</li>-</ul><p><strong>Mesentero-axial volvulus</strong></p><ul>-<li>less common in adults, but is more common than an organo-axial volvulus in the paediatric population (59% of gastric volvulus).</li>-<li>rotation around short axis from the lesser to greater curvature (usually incomplete, less than 180°).</li>-<li>displacement of antrum above GEJ; stomach appears upside-down with the antrum and pylorus superior to the fundus and proximal body</li>-<li>coincides with the axis of mesenteric attachment and is associated with severe obstruction and strangulation. </li>-<li>less associated with diaphragmatic defect.</li>-<li>plain films may show an intra-thoracic stomach with two air fluid levels <sup>1</sup>.</li>- +</li>
- +<li>incomplete (less than 180') also called organo-axial position of the stomach, usually asymptomatic</li>
- +<li>complete (more than 180') present with obstruction or ischemia</li>
- +</ul><h5>Mesentero-axial volvulus</h5><ul>
- +<li>less common in adults, but is more common than an organo-axial volvulus in the paediatric population (59% of gastric volvulus).</li>
- +<li>rotation around short axis from the lesser to greater curvature (usually incomplete, less than 180°).</li>
- +<li>displacement of antrum above GEJ; stomach appears upside-down with the antrum and pylorus superior to the fundus and proximal body</li>
- +<li>coincides with the axis of mesenteric attachment and is associated with severe obstruction and strangulation. </li>
- +<li>less associated with diaphragmatic defect.</li>
- +<li>plain films may show an intra-thoracic stomach with two air fluid levels <sup>1</sup>.</li>
-<li>-<a title="Wandering spleen" href="/articles/wandering-spleen">wandering spleen</a> <sup>2</sup>-</li>-<li><a title="Congenital diaphragmatic hernia" href="/articles/congenital_diaphragmatic_hernia">congenital diaphragmatic herniataion</a></li>-<li><a title="diaphragmatic eventration" href="/articles/diaphragmatic-eventration">diaphragmatic eventration</a></li>-<li>-<a title="laparoscopic adjustable gastric banding" href="/articles/laparoscopic-adjustable-gastric-banding">laparoscopic adjustable gastric banding</a> <sup>4</sup>-</li>- +<li>
- +<a href="/articles/wandering-spleen">wandering spleen</a> <sup>2</sup>
- +</li>
- +<li><a href="/articles/congenital-diaphragmatic-hernia-1">congenital diaphragmatic herniataion</a></li>
- +<li><a href="/articles/diaphragmatic-eventration">diaphragmatic eventration</a></li>
- +<li>
- +<a href="/articles/laparoscopic-adjustable-gastric-banding">laparoscopic adjustable gastric banding</a> <sup>4</sup>
- +</li>
Images Changes:
Image ( update )
Caption
was changed:
Case 9 -: mesentero-axial
Image 1 Diagram ( update )
Caption
was changed:
Image 2 Fluoroscopy (Barium meal) ( update )
Caption
was changed:
Case 1 -: organo-axial
Image 3 Diagram ( update )
Caption
was changed:
Image 5 X-ray ( update )
Caption
was changed:
Case 6 -: organo-axial
Image 6 X-ray (Frontal) ( update )
Caption
was changed:
Case 7 -: mesentero-axial - plain film
Image 8 Fluoroscopy (Barium meal) ( update )
Caption
was changed:
Case 2 -: organo-axial
Image 9 Fluoroscopy ( update )
Caption
was changed:
Case 3 -: with diaphragmatic rupture
Image 10 Barium ( update )
Caption
was changed:
Case 5 -: organo-axial
Image 11 Fluoroscopy ( update )
Caption
was changed:
Case 10 -: organoaxial volvulus
Image 12 CT (C+ arterial phase) ( update )
Caption
was changed:
Case 4 -: with diaphragmatic hernia
Image 13 CT (C+ portal venous phase) ( update )
Caption
was changed:
Case 7 -: mesentero-axial - CT
Image 14 CT (C+ portal venous phase) ( update )
Caption
was changed:
Case 8 -: mesentero-axial
Unable to process the form. Check for errors and try again.