Gastric volvulus (GV) is a rare surgical emergency, defined by the abnormal rotation of a part of the stomach around another part, leading to obstruction, and in some cases, tissue ischemia and necrosis. Anatomically, most cases are either organoaxial volvulus, occurring along the stomach’s longitudinal axis from the gastroesophageal junction to the pylorus, or mesenteroaxial volvulus, occurring perpendicular to the longitudinal axis, such that the pylorus and antrum come to lie above the gastroesophageal junction. Associated contributory diaphragmatic anomalies are common, especially in neonates, while splenic anomalies are also frequent.
GV may present as an acute or chronic condition. The mode of presentation varies depending on age. Neonates and infants may present with respiratory distress, non-bilious vomiting, excessive salivation, and regurgitation of feeds. Older children may present with Borchardt’s triad of non-productive retching, localized epigastric swelling, and failure to pass a nasogastric tube.
Diagnosis relies on index of suspicion, and is aided by plain radiography of the chest and abdomen, and upper gastrointestinal contrast series to clarify the anatomical orientation of the stomach. Suggestive plain radiography findings include spherically distended stomach with two air-fluid levels or a double retrocardiac air-fluid level, as is the case with intrathoracic GV.
In acute GV, surgery is the management of choice and involves correction of any contributory anatomical abnormalities such as diaphragmatic hernia as well as fixation of the stomach to the anterior abdominal wall with a gastrostomy and/or anterior gastropexy. Minimally invasive approaches are being more frequently employed to achieve these goals.
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