Acute Gastric Volvulus: Diagnosis and Management over 10 Years

Abstract

Background/Aims: Gastric volvulus is a rare, potentially life-threatening condition, which is difficult to diagnose. This study represents a series of patients with acute gastric volvulus. Methods: All patients presenting with acute gastric volvulus over a 10-year period were reviewed. Results: Twenty-one patients with a median age of 66 years were identified. Acute gastric volvulus was secondary to a paraesophageal hiatus hernia in 16 patients. The major symptoms were abdominal pain, vomiting and upper gastrointestinal bleeding/anemia. The most useful investigations were barium studies and upper gastrointestinal endoscopy. Treatment was open surgery in all patients. There were no major complications and no deaths. Median hospitalization was 8 days. Conclusion: Acute gastric volvulus is a rare condition which requires a high index of suspicion for diagnosis, which is usually based on imaging studies. The treatment is immediate surgery. Volvulus can be treated successfully by open surgery with minimal morbidity and short hospitalization.

Abdominal pain with a twist: a rare presentation of acute gastric volvulus

“…A combination of both is the rarest form [5,6]. Gastric volvulus can present either as an acute or chronic presentation, classical triad is present in 70% of the cases presenting as severe epigastric abdominal pain and distension, vomiting followed by non-productive retching, and inability to pass NG tube [1-3]. In a review looking at 21 patients, it was found that abdominal pain, vomiting and upper GI bleeding were the most common presenting symptoms [1].…”

“…Gastric volvulus can present either as an acute or chronic presentation, classical triad is present in 70% of the cases presenting as severe epigastric abdominal pain and distension, vomiting followed by non-productive retching, and inability to pass NG tube [1-3]. In a review looking at 21 patients, it was found that abdominal pain, vomiting and upper GI bleeding were the most common presenting symptoms [1]. The chronic presentation on the other hand could manifest with recurrent non-specific abdominal pain, abdominal fullness, chest pain, retching, acid reflux, and dysphagia [3].…”

“…The cause of chronic volvulus and incidence of conversion to acute cases remain unknown [3]. Paraesophageal hiatal hernia was found to be present in 16 of 21 patients in one review looking at different case reports [1]. …”

“…Furthermore, CT imaging can potentially detect other causes of abdominal pain in the absence of gastric volvulus. Barium studies have been reported to have the highest yield (81%) per one review paper looking at 21 cases [1]. …”

“…Gastric volvulus can present either as an acute or chronic presentation. The classical presentation is known as Borchardt’s triad which includes severe epigastric abdominal pain and distension, vomiting followed by non-productive retching, and inability to pass a nasogastric (NG) tube [1]. This triad has been reported to occur in 70% of cases and represents total gastric obstruction [2,3].…”