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Background: Surgery is the mainstay of treatment for gastric volvulus. Despite its rarity, early experience from recent publications suggests that laparoscopy is a safe and effective approach for t... more...

The gastric volvulus is defined as an abnormal rotation of all or part of the stomach around one of its axes, creating the conditions of an upper abdominal obstruction with gastric dilation and risk of strangulation. It is a rare entity that requires a surgical treatment, and its diagnosis is often delayed due to frequently aspecific symptoms. We will describe the observation of a 62 year old patient who presented to the emergency department for acute epigastric pain with dyspnea. The thoracoabdominal CT has demonstrated a stasis stomach on pyloric obstacle evoking a gastric torsion. An upper gastrointestinal endoscopy (EGD) and an upper gastrointestinal contrast made it possible to diagnose an acute gastric volvulus on hiatal hernia. A midline laparotomy was performed with detorsion of the stomach and repair of the hiatal hernia. The patient recovered gradually and was discharged on the sixth postoperative day. Three months after the operation, the patient remained asymptomatic. more...

Acute gastric volvulus is a rare surgical emergency which can lead to severe complications such as gastric ischaemia and perforation. Gastric volvulus is classified by the axis upon which the stomach rotates into organo-axial and mesentero-axial subtypes, with the former more common in adults. We present an uncommon case of recurrent adult mesentero-axial gastric volvulus and describe the associated radiological findings. more...

Introduction and importance Gastric volvulus is the abnormal gastric rotation upon itself. It carries a considerable risk for gastric strangulation which may lead to gangrene and perforation, which can be fatal. It commonly presents with non-specific and vague abdominal symptoms making prompt diagnosis and management imperative. This is a case report describing a case of acute organo-axial gastric volvulus. Case presentation A 74-year-old female, with no comorbidities, presented to our department with non-specific abdominal symptoms. Gastric outlet obstruction was suspected. The patient was reviewed by the gastroenterologist and was offered an urgent upper endoscopy. The upper endoscopy findings described a gastric volvulus, and a Computed Tomography (CT) scan was done to confirm the diagnosis. The patient underwent exploratory/diagnostic laparoscopy and successful reduction and fixation followed. There was no evidence of tissue compromise or ischemia. The patient was discharged on post-operative day 4 following an unremarkable postoperative course. Clinical discussion Acute gastric volvulus is a surgical emergency which can be associated with a high morbidity and mortality, if complications occur. The most important factor in diagnosing acute volvulus of the stomach is a high index of suspicion of the clinical symptoms and should be confirmed by imaging. Contrast enhanced computed tomography (CT) scan is the preferred imaging modality. Urgent surgical intervention is needed to prevent potentially fatal complications. Conclusion Acute Gastric Volvulus is rare and carries the risk of significant morbidity and mortality. Prompt recognition and treatment is required to prevent complications., Highlights • Acute gastric volvulus is a rare potentially life-threatening condition. • Prompt diagnosis and treatment is vital to improve patient outcome. • Contrast enhanced Computed Tomography is the preferred imaging modality used to confirm the diagnosis of gastric volvulus. • Surgical repair is the treatment of choice. more...

Gastric volvulus is an abnormal rotation of the stomach around itself. It is a life-threatening condition due to the risk of abs ingestis pneumonia or strangulation and gangrene/perforation of the stomach. Imaging as X-ray transit of the first digestive tract or Thoracic CT Scan is usually diagnostic. The population affected ranges from pediatric age group to elderly with multiple co-morbidities. The mortality from acute gastric volvulus is now 15%-20%. An 80-year-old Caucasian man was admitted to Emergency Room of our institution for dysphagia, vomiting and epigastric pain. His past medical history was negative for previous gastrointestinal disease or surgery. He referred only dysphagia for solid food and mild retrosternal pain. On physical examination, the patient was in slight distress. Oxygen saturation on pulse oximetry was 85%, blood pressure (BP) was 90/75 mmHg while supine, heart rate was 100/min and the temperature was 36°C. On auscultation, he had breath sounds were bilaterally reduced. His abdominal physical examination was unremarkable. The abdomen was soft, non-tender, mildly distended. White blood tests were in normal range. Computed Tomography (CT) scan showed the displacement of the stomach above the gastro esophageal junction; the stomach appeared upside-down with the antrum showing huge gastric distension with no free fluid or air. We performed an exploratory laparoscopy which confirmed the intra-thoracic rotation of the stomach. We proceed to release it from its adherence from the thorax to the abdomen and complete the operation with a laparoscopic Nissen Fundoplication. Postoperative recovery was uneventful. Esophagus transit was normal. At the 3-day, the patient was in good clinical condition and he was discharged. more...

Acute gastric volvulus is a rare condition complicating 4% of hiatus hernias. It is a more or less complete rotation of the stomach around a transverse or longitudinal axis. It can lead to perforations due to ischemic gastric wall necrosis with very poor prognosis (30% of mortality). We here report the case of an 89-year old female patient with chronic bronchopathy, presenting with epigastralgias associated with vomiting which had progressed for 03 days. Physical examination showed febrile patient at 38.5 with dyspnea (SpO2 88% at room air). Her appearence suggested infection, the abdomen was soft, tender at the level of the epigastrium. Laboratory test showed SBI (WBCs= 22000, CRP= 80). Abdominal CT scan showed hiatus hernia associated with significant gastric distension with wall defect in the anterior face of the stomach associated with pneumatosis in the gastric wall. The patient underwent surgery using a median approach, which showed voluminous hiatus hernia containing the greater curvature of the stomach. Distended stomach was restored to its normal intra-abdominal position. The anterior face of the greater tuberosity was the seat of several areas of necrosis. Total gastrectomy with manual oesojejunal anastomosis associated with Roux-en-Y gastric bypass was performed. The postoperative course was complicated by acute respiratory distress syndrome (ARDS). The patient died on day 8 after emergency hospital admission. Gastric volvulus is a rare condition, which can lead to extremely severe consequences. CT scan allows for thoracic lesion assessment and to study stomach vitality. The treatment of choice is based on surgery. more...

This study aimed to review pediatric cases of acute gastric volvulus, explore the distinguishing features, and outline the diagnosis and management of this life-threatening condition. We searched PubMed, ScienceDirect, and Ovid Medline in March 2018 for cases of gastric volvulus in the pediatric age range ( more...

Acute gastric volvulus is a life threatening condition requiring early diagnosis and aggressive management. Diagnosis of gastric volvulus remains a challenge for clinicians due to variable, non-specific clinical presentation, which requires a high level of suspicion. It should be considered in patients presenting with chest pain and/or epigastric pain, especially in the elderly population. Endoscopic de-rotation could be initially attempted as a therapeutic modality especially in patients who cannot undergo surgery. However, surgery remains the main stay of treatment. Delay in diagnosis can lead to complications like mucosal ischemia, necrosis or perforation, shock, which substantially increase the morbidity and mortality. more...

Highlights • Acute gastric volvulus is an uncommon surgical emergency requiring timely action. • High index of clinical suspicion needed for diagnosis. • Early intervention can save lives and lessen the associated high mortality. • Primary gastric volvulus may be associated with general laxity of ligaments. • Primary gastric volvulus may be linked to fibrosis in active pulmonary tuberculosis., Introduction Gastric volvulus is an uncommon disorder and can present either in the acute or chronic setting with variable symptoms. A robust blood supply of the stomach from different sources does not allow ischemia to develop early. When it occurs in the acute scenario, patients present with severe epigastric pain and retching without vomiting. Together with inability to pass nasogastric tube, they constitute Borchardt’s triad. Presentation of case We report a case which presented in the emergency department with severe abdominal pain, abdominal distension and vomiting and a previous history of pulmonary tuberculosis. An incidental finding of uterovaginal prolapse was present. A diagnosis of acute gastric volvulus with peritonitis was made and total gastrectomy with Roux-en-Y esophagojejunostomy for gangrenous and perforated stomach was performed. Discussion Primary gastric volvulus occurs in the absence of any defect in the diaphragm or adjacent organ pathology and may be caused by weakening of gastric supports. We wish to highlight if there is a possible association of primary gastric volvulus with uterovaginal prolapse reflecting a general laxity of body ligaments or with fibrosis of the lung secondary to pulmonary tuberculosis resulting into the twisting of the stomach. Conclusion Acute gastric volvulus is a surgical emergency requiring early diagnosis and aggressive management, as a delay results into complications like gangrene and perforation which substantially increase the morbidity and mortality in these patients. more...

Gastric volvulus is a rare and life-threatening condition that involves the abnormal rotation of the stomach around its axis by more than 180°. The association between acute gastric volvulus and atrial fibrillation with rapid ventricular response is rare with only few cases that have been reported. Our patient was an 86-year-old female who presented with upper abdominal pain, distension, nausea, and shortness of breath. Clinical and laboratory workup revealed acute gastric volvulus with diaphragmatic hernia. On presentation, she was also in atrial fibrillation with rapid ventricular response. She was successfully treated by laparotomy with reduction of the gastric volvulus and repair of the diaphragmatic hernia, with significant improvement. more...

Summary We present a case of gastric volvulus in a 91-year-old woman. The patient presented with abdominal pain, recurrent episodes of hematemesis, acute respiratory failure, and severe hypotension. The diagnosis of gastric volvulus was suspected by esophagogastroduodenoscopy, and confirmed later by both esophageal and upper gastrointestinal contrast study and abdominal computed tomography. Management consisted of intubation and mechanical ventilation, fluid loading and transfusion, vasopressor infusion, and surgical reduction of the volvulus. more...

Gastric volvulus is an uncommon, but severe pathology requiring early diagnosis and urgent treatment. Its atypical symptoms and rarity make it difficult to diagnose, possibly leading to delayed treatment and fatal complications.We present a case of a 73-year-old patient with Parkinson's disease with complaints of severe epigastric pain, emesis and an increased lipase.Diagnosis of an organo-axial gastric volvulus was made. Treatment consisted of reduction of the volvulus by decompression via nasogastric tube. The underlying cause was a para-esophageal hernia that was repaired by Nissen-fundoplication later on.We describe symptomatology, diagnostic and therapeutic options of gastric volvulus. more...

We report a case of a 6-year-old female with acute gastric volvulus with total gastric necrosis and ischemia of the surrounding organs. Congestion necrosis occurs because of strangulation. It is considered that this case was caused by elevated intragastric pressure with marked stomach dilation. Thus, rapid decompression was essential. Keywords: Acute gastric volvulus, Total gastric necrosis, Ischemia of surrounding organs, Acute gastric dilatation more...

Acute gastric volvulus on diaphragmatic hernia is a rare and life-threatening condition, which is seen mostly in fifth decade of life. Presented with vague symptoms of abdominal pain mostly epigastric in nature, retching, may or may not be associated with vomiting, hematemesis, sometime difficult to pass nasogastric tube (Borchardt triad’s). Hereby we report a case of 48 year old male with known case of kyphoscoliosis who came with hematemesis and vomiting only; on investigation chest with abdomen X ray, USG, upper GI scopy and CT chest with abdomen, suggestive of gastric volvulus with diaphragmatic hernia and kyphoscoliosis. Patient was operated; as in acute gastric volvulus delay may result in complication like perforation and gangrene which can lead to increase morbidity and mortality in this patient; derotation of stomach done and diaphragmatic defect repaired with meshplasty, gastropexy with gastrostomy done. Postoperative course was uneventful. more...

Small bowel obstruction is a common clinical problem presenting with abdominal distention, colicky pain, absolute constipation and bilious vomiting. There are numerous causes, most commonly attributed to an incarcerated hernia, adhesions or obstructing mass secondary to malignancy. Here we present an unusual cause of a small bowel obstruction secondary to an incarcerated incisional hernia in association with an acute organoaxial gastric volvulus. more...

Congenital diaphragmatic hernia (CDH) is the result of the incomplete fusion and closure of the pleuroperitoneal canal during the fetal development. CDH is usually diagnosed prenatally but, if undiagnosed, the clinical presentation ranges from asymptomatic children to serious respiratory or gastrointestinal symptoms. Acute gastric volvulus associated with CDH is a rare surgical emergency in children. We report two cases of acute gastric volvulus associated with CDH and review the literature. more...

Acute gastric volvulus is a life-threatening condition, but its intermittent nature and vague symptoms may make diagnosis difficult. Imaging is usually only diagnostic if carried out when patients are symptomatic. The population affected ranges from paediatric age group to elderly with multiple co-morbidities. Laparoscopic repair is advisable once a diagnosis is reached. This review on gastric volvulus focuses on the diagnostic and management challenges encountered, together with strategies for dealing with them. Lessons have emerged which may assist in dealing with such a rare presentation in future. more...

INTRODUCTION. Gastric volvulus is an important cause of nonbilious emesis that must be recognized early to ensure a good outcome. We reviewed 7 cases from our institution, Children's Healthcare of Atlanta (Egleston campus). In addition, we reviewed all gastric volvulus cases in children published to date in the English literature to draw general conclusions about the presentation and treatment of this unusual disease.METHODS. An electronic literature search was performed to find all published cases of pediatric gastric volvulus. The care of all children from January 2002 to December 2007 who were treated for gastric volvulus was also reviewed.RESULTS. There have been 581 cases of gastric volvulus in children published in English between 1929 and 2007. Of these, 252 were acute and 329 were chronic cases. The most common presentation of acute gastric volvulus is in a child CONCLUSIONS. Acute gastric volvulus is a potentially life-threatening occurrence with a good outcome when treated in a timely fashion. Chronic volvulus may be more difficult to recognize. The common features of acute and chronic gastric volvulus described in this review should assist pediatric health care providers in promptly diagnosing and treating this disease. more...

Background: Acute gastric volvulus is a rare but potentially life-threatening cause of upper gastrointestinal obstruction. Therefore, emergency physicians must maintain a high index of suspicion when patients present signs and symptoms suggesting foregut occlusion. Surgical treatment of gastric volvulus, secondary to diaphragmatic eventration, can vary with no standard routines. In this communication, we discuss the value of a laparoscopic gastric sleeve to prevent recurrence. more...

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. more...

Here, we report two interesting cases of gastric necrosis in acute gastric volvulus due to eventration of the diaphragm. Both the cases presented with a significant challenge and were managed successfully. The management of the cases is presented and relevant literature is discussed. To the best of our knowledge, this is the first case report of gastric volvulus with gastric necrosis requiring complete and partial gastrectomy in the available English literature. more...

Gastric outlet obstruction initiated by acute gastric volvulus is rare but potentially fatal. An unusual case of intrathoracic acute gastric volvulus complicated by distal stomach and transverse colon herniation into retrocardial space is reported. Prompt clinical diagnosis was followed by emergency laparoscopic de-rotation and gastropexy. more...

Gastric volvulus is a rare cause of acute abdomen in pediatric practice. It is defined as the twisting of the stomach around its longitudinal or transverse axis. The symptoms are variable and not specific. It is often associated with a diaphragmatic defect or unfixed stomach. Herein we report a rare observation in a case of an 18 month old infant who presented with abdominal distension and vomiting. The insertion of a nasogastric tube was laborious and blurred the symptoms. Conventional radiography was very not contributive. The exploratory laparotomy allowed making the diagnosis of a gastric volvulus in its organo-axial form associated with wandering spleen. Untwisting associated with gastropexy seemed to be the procedure of choice for these patients. more...

Gastric volvulus has been reported in all age groups; however, it is typically diagnosed in the elderly. Organo-axial volvulus is the most common type, followed by the mesentero-axial and the combined types. Depending on the etiology, gastric volvulus can also be classified as primary (idiopathic) or secondary. Treatment of acute gastric volvulus involves laparoscopic or endoscopic procedures/maneuvers, depending on the severity of symptoms and surgical eligibility of the patient. Chronic gastric volvulus is typically managed conservatively, although laparoscopic or endoscopic interventions can also be employed depending on the severity of presentation. more...

Acute gastric volvulus is an infrequent entity. Management is surgical. Diagnosis frequently is delayed because of the non-specific nature of presenting symptoms. The authors report a case of acute gastric volvulus diagnosed by computed tomography in a 92 year old woman that was confirmed at surgery. The pathophysiology, classification and different presentations of this entity are briefly reviewed. CT findings suggesting gastric volvulus are reviewed as well. more...

Diaphragmatic hernia may be congenital or traumatic in origin. Traumatic hernia may menifest immediately or several months/years after the incident. Congenital hernia usually manifests in the early years of life. Diaphragmatic hernia may be complicated by gastric volvulus. Acute gastric volvulus is surgical emergency where as chronic gastric volvulus presents with nonspecific abdominal symptoms. Diagnosis of gastric volvulus is difficult and is based on imaging studies. We describe four cases of diaphragmatic hernia complicated by gastric volvulus, diagnosed on imaging and managed surgically. more...

Acute gastric volvulus is a torsion of the stomach by more than 180° and a life-threatening condition. We present a 50-year-old male patient with acute abdominal pain who has Down syndrome/trisomy 21. Computed tomography showed a significant distended stomach with features of a severe gastric volvulus. Emergency operation in form of reduction and gastropexy was performed. We are not aware of any similar cases published in the English literature, where as gastric volvulus occurred in a patient with Down syndrome. more...

Summary: We report a case of an acute strangulated gastric volvulus in a hernia of Bochdalek in an adult female patient that was repaired successfully via the laparoscopic approach. A left-sided diaphragmatic hernia contained a strangulated but viable gastric volvulus and a noncompromised colon. The contents of the hernia were reduced, and the 4-cm congenital diaphragmatic defect was primarily repaired with nonabsorbable sutures. The patient was discharged on the second postoperative day and remained symptom-free at 7 months. Unlike the very few previous reports of elective laparoscopic repair of uncomplicated Bochdalek hernias, this appears to be the first report of an urgent laparoscopic repair of a complicated hernia of this type. more...

Gastric volvulus is a rare but potentially life-threatening cause of upper gastrointestinal obstruction. Emergency physicians must maintain a high index of suspicion in patients who present with signs and symptoms suggesting foregut occlusion. We report an illustrative case and review the pathogenesis, classification, diagnosis and treatment of this rare entity. more...

An 11-year-old girl with cerebral palsy was admitted with complaints of frequent vomiting and upper abdominal distension. After plain X-ray examination and upper gastrointestinal contrast study, she was diagnosed as having acute mesenterioaxial volvulus of the stomach. Endoscopic reduction was successfully performed. We describe herein the technical details of the endoscopic reduction in this rare case. In non-infant pediatric patients with primary gastric volvulus, we recommend that endoscopic reduction be considered prior to surgical intervention. more...

Gastric volvulus is an uncommon entity that may rapidly progress to infarction and necrosis of the stomach. We herein report the case of a 67-year-old man with acute gastric volvulus in association with wandering spleen. Following a reduction of the volvulus with a nasogastric tube, laparoscopic gastropexy was performed. Pediatric cases of gastric volvulus and a concurrent wandering spleen have been described, but to the best of our knowledge, no adult cases have previously been reported. more...

Gastric volvulus, especially cases with an acute onset, may result in strangulation, perforation, peritonitis, shock and death. The disease is rarely seen in children, but early diagnosis and treatment is essential due to its life-threatening potential. In patients with acute gastric volvulus, the clinical Borchardt triade may be observed, which is characterized by acute severe pain and distension in the upper abdomen or lower thoracic region, retching and the inability to pass a nasogastric tube. In this article, We aimed to emphasize the Borchardt’s triad by presenting a pediatric case who was diagnosed with Borchardt’s triad and who had acute mesenteric axial gastric volvulus which diaphragmatic hernia and mobile (wandering) spleen were accompanied. more...

Acute gastric volvulus is a rare, but potentially life-threatening, cause of upper gastro-intestinal obstruction. The diagnosis can prove clinically challenging, and hence there is increased reliance on imaging. There are different types of gastric volvulus, with the variant presented in our case being the less commonly encountered mesenteroaxial gastric volvulus. Some of the CT features of gastric volvulus are described, and the usefulness of CT in assisting with the diagnosis is highlighted. more...

Eventration of the diaphragm with gastric volvulus is uncommon. Gastric perforation in these cases is rare and usually associated with acute gastric volvulus with strangulation. We describe a case of diaphragmatic eventration with chronic gastric volvulus with gastric perforation without strangulation in an elderly man. more...

Acute gastric volvulus is a rare acute life-threatening surgical emergency that involves abnormal rotation of the stomach along one or both of its axes by more than 180° resulting in closed-loop obstruction. Acute gastric volvulus can result in complications such as gastric ischemia, necrosis, and perforation; as a consequence, it requires rapid recognition and need immediate surgical treatment [1, 2]. Gastric volvulus has been classically classified into: (1) organoaxial (OA), when the stomach rotates around an axis line connecting the gastroesophageal junction and pylorus (Fig. 1a), (2) mesentero-axial (MA), when the stomach rotates around an imaginary transverse line connecting the middle of lesser and greater curvatures of the stomach (Fig. 1b), and (3) mixed-type (MT), when features of both OA and MA are present. The role and radiological features of upper gastrointestinal barium studies in acute gastric volvulus has just been extensively described [3, 4]. However, a patient presenting to emergency room with an acute abdomen may undergo directly a CT scan as first imaging examination. As a consequence, the radiologist should be confident with the tomographic appearance of this pathology. We describe the CT findings of a MT acute gastric volvulus. more...

Paraesophageal hernia is the second most type of hiatal hernias. It is a known predisposing factor for gastric volvulus. When acute gastric volvulus occurs, early diagnosis before strangulation and incarceration will be life-saving. We are presenting a case with paraesophageal hernia and gastric volvulus with unusual radiologic findings. The patient came to emergency room with acute symptoms. The diagnosis was made with multidetector computed tomography (MDCT). Three spherical gas bubbles were seen in the chest X-ray. Two of them were intrathoracic and the third one was intraabdominal. MDCT showed that most of the stomach was in the chest alongside the esophagus. Gas in the portal veins and gastric wall was also seen. The patient was treated with surgery. © 2009 Elsevier Ireland Ltd. All rights reserved. more...

Acute gastric volvulus is an uncommon condition with severe repercussions if untreated in the acute presentation. We describe such a case. We assert that computed tomography (CT) should be the first line of investigation. more...

Gastric volvulus in infants, children, and adolescents is a rare event. The purpose of this study is to examine this congenital abnormality and its consequences, using cases with significant adverse outcomes. We will specifically discuss issues of diagnosis and treatment of acute gastric volvulus in association with diaphragmatic anomalies. In addition, the different types of gastric volvulus are compared and contrasted, highlighting areas that may allow for early recognition and prevention of complications related to this foregut obstructive process. Three clinical cases are reviewed, all with significant morbidity and/or mortality. These cases are combined with larger case series to arrive at a list of relatively specific clinical and radiologic findings that can alert the clinician to this diagnosis and thus expedite the child's assessment and treatment, averting major complications. more...

Introduction Gastric volvulus is a rare, potentially life-threatening condition, which is difficult to diagnose. This study presents a series of acute gastric volvulus in neonates with the aim of describing this rare disease and its varied clinical manifestations. Material and methods The data of all neonates presenting with acute gastric volvulus between January 2001 and January 2007 was retrospectively reviewed. Diagnosis was made on suspicion and was documented by a barium study. All patients were operated by open anterior gastropexy with or without a feeding gastrostomy. Results Four patients were male and 1 was female. All were treated with gastropexy with or without feeding gastrostomy. Four patients recovered well after surgery. There was one postoperative death. Conclusion Gastric volvulus is extremely rare in neonates but it should be considered in the differential diagnosis after sudden onset or recurrent vomiting in the pediatric age group. Early diagnosis and treatment gives excellent results. more...

In this era of modern technologies, laparoscopic adrenalectomy is a gold standard surgical treatment for benign adrenal lesions. However, being aware of its difficulties and their managements is a very important issue for the surgeons who are interested in minimal invasive surgery. In this article, we are presenting a case of a 57-year-old woman who has undergone laparoscopic left adrenalectomy and in the third postoperative month, had an acute gastric volvulus requiring surgical open treatment. To the best of our knowledge, this report is the first article about a gastric volvulus case after left laparoscopic adrenalectomy. more...