Gastric Volvulus

DEFINITION
Rotation of the stomach on its longitudinal axis (organoaxial) or across a line from mid lesser to mid greater curvature (mesenteroaxial).

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EPIDEMIOLOGY

Incidence


Age

Gender

Geographical distribution

Risk factors
Personal

Environmental

Family

Predisposing conditions

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AETIOLOGY

Pathogenesis


Sieve

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BIOLOGICAL BEHAVIOUR

Pathophysiology


Organoaxial volvulus is more common.
- associated with paraesophageal hiatal hernia.

Chronic is more common than acute

Natural history
Acute Volvulus
Gastric necrosis and shock rapidly ensue.


Complications

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MANIFESTATIONS

Symptoms


Acute

Diagnostic triad:
- severe abdominal pain accompanied by:
i) vomiting, retching, then inability to vomit
ii) epigastric distension
iii) inability to pass an NG tube

Chronic

Intermittent cramping pains.

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INVESTIGATIONS
Biochemistry

Haematology

Microbiology

Imaging

Other

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MANAGEMENT

Conservative



Medical


Operative
Acute volvulus
Urgent laparotomy is indicated.

Chronic
Cases associated with paraesophgeal herna should be repaired + with anterior gastropexy.
Eventration of the diaphragm may be present
- gastrocolic ligament may need to be divided along length of curvature.  Colon elevates, stomach can be fastened with pexy.

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REFERENCES

Doherty