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Gastric volvulus

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Title: Gastric volvulus  
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Gastric volvulus

Gastric volvulus
Classification and external resources
ICD-10 K31.8
ICD-9 537.89
DiseasesDB 32054
eMedicine med/2714 radio/296

Gastric volvulus or volvulus of stomach a twisting of all or part of the hiatus hernia. Treatment is surgical.

The classic triad of gastric volvulus, described by Borchardt in 1904, consists of severe epigastric pain, retching without vomiting, inability to pass a nasogastric tube and sometimes severe pain at the top of left shoulder, this may be due to internal bleeding irritating the diaphragm upon respiration.

Classification

Organoaxial type

In an organoaxial gastric volvulus, the stomach rotates around an axis that connects the gastroesophageal junction and the pylorus. The antrum rotates in opposite direction to the fundus of the stomach.

Mesentericoaxial type

The mesentericoaxial axis bisects the lesser and greater curvatures. The antrum rotates anteriorly and superiorly so that the posterior surface of the stomach lies anteriorly. The rotation is usually incomplete and occurs intermittently. Vascular compromise is uncommon. This etiology comprises approximately 29% of cases of gastric volvulus.

Etiology

Type 1

Idiopathic gastric volvulus comprises two thirds of cases and is presumably due to abnormal laxity of the gastrosplenic, gastroduodenal, gastrophrenic, and gastrohepatic ligaments.

Type 2

Type 2 gastric volvulus is found in one third of patients and is usually associated with congenital or acquired abnormalities that result in abnormal mobility of the stomach.

Prognosis

The nonoperative mortality rate for gastric volvulus is reportedly as high as 80%.

References

  • Schaefer D, Nikoomenesh P, Moore C (1997). "Gastric volvulus: an old disease process with some new twists". Gastroenterologist 5 (1): 41–5.  
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