Gastric volvulus is a rare clinical entity defined as an abnormal rotation of the stomach of more than 180°, creating a closed loop obstruction that can result in incarceration and strangulation.
* This type comprises 2/3 of cases and is presumably due to abnormal laxity of the gastrosplenic, gastroduodenal, gastrophrenic, and gastrohepatic ligaments. This allows approximation of the cardia and pylorus when the stomach is full, predisposing to volvulus.
* This type is more common in adults but has been reported in children.
* This type is found in 1/3 of patients and is usually associated with congenital or acquired abnormalities that result in abnormal mobility of the stomach.
* Congenital defects as:
-Diaphragmatic defects - 43%
-Gastric ligaments - 32%
-Abnormal attachments, adhesions, or bands - 9%
-Asplenism - 5%
-Small and large bowel malformations - 4%
-Pyloric stenosis - 2%
-Colonic distension - 1%
-Rectal atresia - 1%
The most common causes of gastric volvulus in adults are diaphragmatic defects. In cases of paraesophageal hernias, the gastroesophageal junction remains in the abdomen, while the stomach ascends adjacent to the esophagus, resulting in an upside-down stomach. Gastric volvulus is the most common complication of paraesophageal hernias.
* Massively dilated stomach in LUQ(left upper quadrant) possibly extending into chest
* Inability of barium to pass into stomach (when obstructed)
Frontal radiograph from an upper GI examination shows the stomach
located in the lower chest in a large hiatal hernia. The greater curvature
of the stomach lies superior to the lesser curvature in an organoaxial twist.
Note that the stomach is not obstructed.
Organoaxial and Mesenteroaxial types:
#Organoaxial type:Twist occurs along a line connecting the cardia and the pylorus--the luminal (long) axis of the stomach.
#Mesenteroaxial type:Twist occurs around a plane perpendicular to the luminal (long) axis of the stomach from lesser to greater curvature.