Stomach: Gastric Volvulus

Definition

• Abnormal Axial Rotation of the Stomach Around Itself

Causes

• Primary (Idiopathic) – Due to Gastric Ligament Abnormalities
  • Kyphoscoliosis Can Cause Elongation of Ligaments Increasing Risk
• Diaphragmatic Hernia – Most Common Cause
  • Congenital – Most Common Cause in Peds
  • Paraesophageal – Most Common Causes in Adults
• Wandering Spleen
• Phrenic Nerve Paralysis

Axis

• Organoaxial: Around Longitudinal/Long Axis
  • Antrum Rotates Anterosuperiorly with Fundus Rotates Posteroinferiorly
    • Greater Curvature Rests Above the Lesser Curvature
  • Most Common Rotation
• Mesenteroaxial: Around Short Axis
  • Antrum Rotates Above the GE Junction
  • Typically Not Associated with a Secondary Anatomic Defect
• Complex: Aspects of Both Organoaxial & Mesenteroaxial

Presentation

• Borchardt’s Triad
  • Sudden Severe Epigastric Pain
  • Retching Without Emesis
  • Unable to Pass NGT
• Complications:
  • Obstruction
  • Bleeding
  • Strangulation Causing Ischemia, Necrosis or Perforation

Treatment

• Initial Intervention: NG Tube to Decompress
• Definitive Tx: Surgery
  • Components:
    • Surgical Detorsion & Resect Nonviable Tissue
    • Reduce Hernia & Repair Diaphragmatic Defects
    • For Primary Volvulus Consider Fixation to Abdominal Wall
      • Not Required if an Anatomic Defect is Repaired
• Unstable or Unable to Tolerate Surgery: Endoscopic Detorsion with Double PEG Tubes (To Fixate)
  • If Fails: Surgery