• 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)

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.

Another frontal radiograph from an upper GI examination again 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