659. ORGANOAXIAL GASTRIC VOLVULUS DETERMINING GASTROESOPHAGEAL REFLUX DISEASE: A FORGOTTEN RELATION CAUSE

Gastric volvulus is a rare clinical and occurs when the stomach rotates 180° in its transverse or longitudinal axis. Symptoms may range from mild abdominal pain to volvulus necrosis. Gastroesophageal reflux disease (GERD) is not very often associated with abdominal gastric volvulus. Usually, the volvulus is primary and results from anatomical ligament defects. Organoaxial volvulus is the most common type and is defined by the rotation of the stomach around the Pylorus or Gastroesophageal Junction. Two cases will be presented where the treatment of organo-axial gastric volvulus was performed by video laparoscopy. The literature revision will try to bring some aspects of the problems in missing the diagnosis of the volvulus before operation. Two male patients, 24 and 47 years old, underwent surgery, both with extra-esophageal symptoms of GERD associated with symptoms of gastroparesis. Endoscopy, barium swallow and gastrography, manometry, pHmetry, and scintigraphy gastric emptying test were performed, showing a delayed gastric emptying time leading to reflux in both patients. Both patients had a good evolution after surgery. The release of the gastric anatomical ligaments was performed, as well as the rotated gastric fundus. The gastric fundus was used to perform a partial fundoplication, with the stomach being fixed to the pillars and diaphragmatic surface, fixing the stomach in a normal anatomical position. Gastric volvulus can be an unexpected cause of GERD, and the symptoms usually are refractory without surgical treatment. The appropriate surgical technique can bring good results and symptom relief to patients.