Gastric volvulus: A review of 38 cases

Abstract

BACKGROUND: Gastric volvulus is frequently an asymptomatic disease, and it is usually diagnosed during radiographic examination of the superior digestive tract. The acute form, however, can spawn serious and lethal clinical consequences. This disease is defined by the anomalous rotation of the stomach over itself, and it can be classified according to type, extension, direction, etiology, and clinical presentation. AIM: To review the records from 38 patients with gastric volvulus diagnosed in the Hospital das Clínicas of University of São Paulo between 1968 and 2001. METHODS: This is retrospective analysis of 38 patient records. It was collected from each patient: name, age of first symptom appearance, gender, main clinical findings and complementary exams, volvulus type, extension, direction, etiology, and clinical presentation, therapeutic procedures, type of surgery performed, eventual recurrence, and long-term evolution. RESULTS: It was observed that occurrences of gastric volvulus are mainly secondary (75.8%). For the majority of patients (n=33), surgery was chosen as the treatment option: chronic disease in 29 cases and acute in four. Conservative treatment was reserved only for patients with no clinical conditions to surgical treatment. Anterior gastropexy was associated to high recurrence rates. Suturing the low gastric curve to the hepatic capsule and the transverse colon to the left subphrenic space (Tanner´s operation) seemed to be the technical treatment of choice for primary gastric volvulus. CONCLUSION: Treatment of gastric volvolus must be tailored according the etiology of the disease.

Second-look laparostomy for perforated gangrenous gastric volvulus to prevent total gastrectomy

“…This patient was previously asymptomatic and reported no symptoms of volume reflux or regurgitation. In a review of 38 cases of gastric volvulus, Carlos et al 15 found 50% of patients to have been asymptomatic prior to acute presentation 16…”

Gastric volvulus: a potentially fatal cause of acute abdominal pain

“…In primary gastric volvulus, the mechanism is attributed to laxity of the ligaments supporting the stomach, that is, the gastrocolic, gastrolienal, gastrohepatic and gastrophrenic ligaments. On the other hand, secondary gastric volvulus is more common and is caused by predisposing factors that facilitate rotation of the stomach such as hiatus hernia, traumatic diaphragmatic hernia, gastric tumours and ulcers, diaphragmatic eventration, phrenic nerve palsy and adhesions from other surgeries 1 6 7…”

“…The initial management for acute gastric volvulus includes resuscitation, placement of a nasogastric tube, gastric decompression and resting in the prone position 5 6. Emergency laparotomy is the option of choice to prevent complications such as strangulation, gangrene and perforation 2 4.…”

Acute mesenteroaxial gastric volvulus: A rare cause of haematemesis

“…In addition to ligament alterations, other aetiologies can be involved in volvulus genesis. Congenital or acquired (e.g., postoperative) adhesions or lesions (ulcers or tumours) can provide a basis for gastric rotation [4]. discomfort.…”