• Uncommon
  • May occur in children due to congenital diaphragmatic defects
  • In adults, rarely occurs before age 50
    • Most common cause of gastric volvulus in adults are diaphragmatic defects
• Stomach twists on itself
• Etiologies
  • Abnormality of the suspensory ligaments of the stomach
    • Gastrohepatic
    • Gastrosplenic
    • Gastrocolic
    • Gastrophrenic
  • Unusually long gastrocolic and gastrohepatic mesentery
• Classified as one of two types--organoaxial or mesenteroaxial

 

• Almost always occur with large diaphragmatic hernia like hiatal hernia
  • Especially, paraesophageal hiatal hernias
    • In paraesophageal hernias, gastroesophageal junction remains in abdomen while stomach ascends adjacent to the esophagus
    • Produces “upside-down-stomach”
    • Gastric volvulus is most common complication of paraesophageal hernias
  • Also occurs with eventration of the diaphragm
  • Paralysis of diaphragm
• Despite abnormal placement of stomach, it usually does not become obstructed
  • Sometimes called “partial volvulus” or “torsion” or “chronic volvulus”
  • Twisting up to 180 degrees may cause no obstruction
  • Twisting beyond 180 degrees almost always produces obstruction
    
    
• Clinical findings
  
  
  • Unless acute, patients are frequently asymptomatic
  • When acute and obstructing
    • Abdominal pain
    • Attempts to vomit without results
    • Inability to pass an NG tube
    • Together, these three findings comprise the Borchardt triad which is diagnostic
      of acute volvulus
      • Reportedly occurs in 70% of cases
        
        
• Imaging findings
  
  
  • Massively dilated stomach in LUQ possibly extending into chest
  • Inability of barium to pass into stomach (when obstructed)

Gastric Volvulus. Frontal radiograph from an upper GI examination shows the stomach
located in the lower chest in a large hiatal hernia. The greater curvature
of the stomach lies superior to the lesser curvature in an organoaxial twist.
Note that the stomach is not obstructed.

• Treatment
  
  
  • Surgery in acute gastric volvulus
  • In patients with  chronic gastric volvulus, surgery is performed to prevent complications
    • Nonoperative mortality rate = as high as 80%
    • Mortality rate from acute gastric volvulus = 15-20%
    • Mortality rate from chronic gastric volvulus ranges up to 13%
      
      
• Complications
  
  
  • Gastric emphysema
  • Twisting of stomach may tear spleen from its normal attachments
  • Perforation is rare