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Chest radiograph showing air-filled viscus in an intrathoracic position behind the cardiac silhouette (black arrows).
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Acute and chronic gastric volvulus usually present with different symptoms and affect patients primarily after the fourth decade of life. Volvulus can be diagnosed by an upper gastrointestinal contrast study or by esophagogastroduodenoscopy. There are three types of gastric volvulus: 1) organoaxial (most common type); 2) mesenteroaxial; and 3) a co...
Context in source publication
Context 1
... with acute gastric volvulus typically present with severe epigastric pain and distention, unproductive vom- iting and difficulty with nasogastric tube insertion. This triad of symptoms is known as Borchardt's triad. 1 Carter et al 2 added additional clinical features that include the following: 1) minimal abdominal findings when volvu- lus is intrathoracic; 2) gas-filled viscus in the lower chest or upper abdomen as seen on chest radiograph ( Figures 3 and 4); and 3) obstruction seen on upper GI contrast studies at the site of the volvulus. ...Similar publications
Case Report:
A 42-year-old female presented with longstanding symptoms suggestive of gastroesophageal reflux disease improved after proton pump inhibitor treatment. An upper endoscopy revealed an intrathoracic position of the stomach (type 4 hiatal hernia) with no mucosal abnormality. Barium swallow demonstrated gastric herniation with gastric volv...
Patient: Female, 74
Final Diagnosis: Hiatal hernia with gastric volvulus
Symptoms: Dyspena
Medication: —
Clinical Procedure: —
Specialty: Surgery
Objective
Rare co-existance of disease or pathology
Background
Upside-down stomach (UDS) is the rarest type of hiatal hernia (HH), with organoaxial gastric volvulus. A large HH sometimes causes cardiopu...
Citations
... There are very few cases that describe gastric necrosis requiring resection secondary to volvulus, with most being seen in the pediatric population [9][10][11]. The stomach is a resilient organ that has been shown to resist necrosis even in circumstances where significant arterial supply is compromised, but in cases where both arterial supply and venous drainage have been affected the risk of necrosis is high [4]. ...
... There has been a debate on whether antiref lux surgery is included with the hiatal repair. However, some authors do believe that fundoplication is beneficial after hiatal hernia repair to limit symptoms of ref lux and to provide additional support to the repair [3,11,12]. There is extensive discussion about the role of performing gastropexy without formal hernia repair with data demonstrating high recurrence rates of up to 17% [1]. ...
Hiatal hernias are commonly encountered in clinical practice. In certain cases, especially in large hiatal hernias, gastric volvulus can occur. Patients with volvulus typically will present with vomiting, chest pain, shortness of breath, and dysphagia. In extreme cases, gastric volvulus can result in gastric necrosis requiring partial or total gastrectomy. Here we highlight a case of a 76-year-old female with a known large type IV hiatal hernia who was found to have gastric volvulus with necrosis requiring partial sleeve gastrectomy. This case demonstrates the rare, but possible complication of gastric necrosis secondary to gastric volvulus from a large hiatal hernia, prompting emergent surgical intervention.
... The main principles of surgical intervention include stomach decompression, with volvulus reduction, followed by gastropexy and correction of any predisposing intra-abdominal factors [11]. Indeed, gastric resection should be reserved only for the cases of stomach strangulation and necrosis [11,12]. ...
... The main principles of surgical intervention include stomach decompression, with volvulus reduction, followed by gastropexy and correction of any predisposing intra-abdominal factors [11]. Indeed, gastric resection should be reserved only for the cases of stomach strangulation and necrosis [11,12]. Historically, Tanner has described a wide range of surgical techniques for volvulus correction: fundo-antral gastrogastrostomy (Opolzer's operation), partial gastrectomy, division of bands, gastrojejunostomy, repair of diaphragmatic hernia, simple gastropexy, repair of eventration of the diaphragm and gastropexy with division of the gastrocolic omentum (Tanner's operation) [13]. ...
... Historically, Tanner has described a wide range of surgical techniques for volvulus correction: fundo-antral gastrogastrostomy (Opolzer's operation), partial gastrectomy, division of bands, gastrojejunostomy, repair of diaphragmatic hernia, simple gastropexy, repair of eventration of the diaphragm and gastropexy with division of the gastrocolic omentum (Tanner's operation) [13]. There have been also reports of success in the treatment of gastric volvulus with single or dual percutaneous endoscopic gastrostomy placement (PEG), although it has significant morbidity and may result in gastric rotations initiated by the PEG tubes [4,11]. ...
Introduction and importance
Gastric volvulus is a rare clinical entity which occurs due to the rotation of the stomach and can have life-threatening complications. This condition can have an acute or chronic presentation and its symptoms will vary according to the degree of obstruction and rapidity of onset.
Case presentation
We report a case of a 84-year-old male with history of frequent periods of constipation and lack of appetite who presented to the emergency room with left-sided abdominal pain and distension and persistent nausea, without the ability to vomit. Abdominal radiograph, computed tomography scan of the abdomen, contrast-enhanced examination and upper endoscopy were consistent with a gastric volvulus secondary to diaphragmatic eventration. The patient's symptoms resolved after nasogastric tube placement and fluid resuscitation. However, he was proposed to a laparoscopic anterior gastropexy to prevent symptom recurrence. He remains asymptomatic after 3 years of follow-up.
Clinical discussion
The diagnosis of gastric volvulus is based mainly on clinical presentation and abdominal imaging. The main principles of surgical intervention include stomach decompression with volvulus reduction, followed by gastropexy and correction of any predisposing intra-abdominal factors.
Conclusion
Definitive treatment of both acute and chronic gastric volvulus includes a surgical approach. Laparoscopic anterior gastropexy has been found to be a viable alternative in these patients.
... Laparoscopic surgical procedures are the preferred method of intervention in progressive or acute cases [12]. ...
... Depending on the severity of the volvulus, patients can typically be treated with excision of the hernia sac, an anti-reflux procedure, and laparoscopic placement of a gastronomy tube [12]. The gastronomy tube helps secure the stomach in its proper position and prevents remigration into the thoracic cavity. ...
... The gastronomy tube helps secure the stomach in its proper position and prevents remigration into the thoracic cavity. In cases where full-thickness necrosis is present, a gastric resection is necessary [12]. While this approach has the highest resolution rate of the volvulus, less invasive procedures should be attempted first, when possible. ...
Gastric volvulus is a rare condition that may present with various symptoms and may occur as an acute or chronic condition. Signs and symptoms may include nausea, vomiting, abdominal pain, and chest pain. It is imperative to recognize acute gastric volvulus in a timely fashion, since a delay in diagnosis may result in foregut obstruction and increased risk of strangulation, if not recognized and treated promptly. Additionally, secondary complications that are equally life-threatening, such as cardiac arrhythmias, can occur. For this very reason, it is important to highlight gastric volvulus as a possibility when developing a differential diagnosis in patients complaining of abdominal pain. This case report describes a 73-year-old female with no past cardiac risk factors, who presented to the emergency department (ED) with symptoms of supraventricular tachycardia (SVT), intermittent diarrhea, and nausea per emergency medical services (EMS). Upon EMS arrival at the patient's home, her heart rate was 210 beats per minute (bpm). Despite her condition appearing to result from a cardiac condition, imaging studies found a large hiatal hernia through which the stomach had displaced. The patient's stomach had distended, forming a volvulus and placing pressure on thoracic organs. This case highlights a rare but potentially life-threatening cardiac arrhythmia associated with gastric volvulus.
... • Anemia (related to mucosal ulceration) Reported complications of gastric volvulus include ulceration, perforation, hemorrhage, pancreatic necrosis, and omental avulsion. On rare occasions, rotation of the stomach may even cause disruption of the splenic vessels resulting in hemorrhage and splenic rupture [5,12]. ...
... Due to the paucity of literature comparing laparoscopic and open surgery it is difficult to compare their respective outcomes. However, laparoscopic surgery has largely demonstrated its usefulness in elective surgery for chronic gastric volvulus and increasingly in cases of acute volvulus [7,11,12,[16][17][18]. Koger and Stone in 1993 described the first successful laparoscopic treatment of acute gastric volvulus by performing reduction and gastropexy [11]. ...
... Channer et al. have reported successful reduction of organoaxial gastric volvulus using standard laparoscopic foregut port placement in a small series [12]. Yates et al. have modified the port configuration to allow for sutured gastropexy of the distal gastric body and antrum [18]. ...
Gastric volvulus is one of the most worrisome complications related to large paraesophageal hernias. It is a medical emergency that requires high index of suspicion and prompt management and operation during the index admission. Here we discuss the pathophysiology and classification of gastric volvulus, clinical and radiological presentation, and treatment options. The approaches described here include endoscopic, laparoscopic, robotic and open. We advocate for the first three approaches and usually save the open approach for certain redo operations or patients with significant adhesions from prior mediastinal or foregut surgeries.
... Currently, the mainstay surgical intervention involves decompression of the obstructed stomach using either nasogastric tube or endoscopy followed by laparoscopic repair as reported by Channer and colleagues first in the year 2000. 2 More recent methods of single-incision laparoscopic gastropexy 6 and video-assisted laparoscopy 7 have also been reported with good results. However, most of the data presented in the literature tend to suffer from a short length of follow-up and the exact rate of recurrence of the various techniques; whether it is endoscopic reduction, gastropexy, and/or other surgical correction largely remains unknown. ...
Introduction Gastric volvulus is a rare yet life-threatening condition requiring urgent attention. In this case series and literature review, we present the difficulties in management and outcome in patients with gastric volvulus and suggest a tiered framework to guide management. All consecutive cases at a single institution presenting between January 1, 2010, and June 30, 2020, were included. Chi-squared analyses were undertaken to compare outcomes across different groups. A total of 48 patients presented with gastric volvulus; the median age was 78 years (interquartile range [IQR]: 69–84) and 70.8% were female. Most patients had an ASA score of III (n = 19/48, 39.6%) or IV (n = 14/48, 29.2%). In total, 62.5% (n = 30/48) underwent laparoscopic surgery and mesh was used in 40.0%. Eighteen patients (37.5%) were not suitable candidates for surgery or declined surgery. The median length of stay in those undergoing surgery was 4 days (IQR: 2–6). The complication rate in this cohort was 26.7% (n = 8/30). Of these eight patients, four had postoperative nausea, and four others suffered from pneumothorax, wound hematoma, intra-abdominal bleeding, or intra-abdominal collection. The patient who had a serious intra-abdominal bleed returned to operating room and required blood transfusions on day 1 postsurgery. The readmission rate in the surgery group was 6.6% (n = 2/30), both of who had prolonged nausea and were treated symptomatically. The overall 30-day morality in the surgical group was 3.3%. Over a follow-up period of 37 months, 10.0% had a recurrence of hernia, all of who were managed conservatively. Gastric volvulus is a surgical emergency that is associated with a high rate of morbidity and mortality. A tiered treatment algorithm based on urgency can help deliver timely treatment and standardize care. One in 10 patients post–gastric volvulus repair will have recurrence of para-oesophageal hernia but can be treated conservatively.
... If tissue during this process is deemed to be nonviable then gastrectomy becomes warranted as well. Of note, poor surgical candidates have the alternative option of attempts at endoscopic de-rotation and gastric fixation with subsequent percutaneous endoscopic gastrostomy tube placement [11]. ...
Gastric volvulus is a distinct and uncommon pathology that usually presents with vomiting secondary to gastric outlet obstruction and gastrointestinal bleeding with an association with hiatal hernia. We present a case of a 71-year-old female who presented to the emergency department (ED) with a three-day history of coffee ground emesis. Of note, the patient was recently in the hospital under medical observation two weeks prior, with similar complaints of hematemesis. Chest X-ray revealed a left basilar opacity representing bowel gas suggestive of a hiatal hernia. Intravenous proton pump inhibitors were initiated but due to persistent recurrence of symptoms and progressive discomfort, a computed tomography (CT) of the chest and abdomen was ordered. This revealed a partial gastric volvulus with signs suggestive of vascular compromise of the herniated part of the stomach. She subsequently underwent emergent laparotomy, repair of the hiatal hernia, and partial gastrectomy and gastropexy. Post-surgical biopsy findings showed focal mucosal necrosis and ulceration, focal foveolar hyperplasia, edematous changes, and overall congestion in the submucosal tissue. She was discharged five days later with no complications or recurrence of symptoms.
... On the other hand, in a series by Channer et al., four patients with gastric volvulus and hiatal hernias underwent standard laparoscopic repair including reduction of the volvulus, excision of the hernia sac, re-approximation of the diaphragmatic crura, fundoplication, and anterior abdominal wall gastropexy with a gastrostomy tube. Here the authors reported only one patient with postoperative dysrhythmia and no other major complications (31). However, two of the four patients were younger than 65 years of age without significant medical comorbidities. ...
... In the event of complications such as gangrene and perforation, gastrectomy or partial gastrectomy should be performed. The approach to surgery can be performed by open and laparoscopic techniques [22][23][24]. The laparotomy is the most used especially in case of acute volvulus allowing broad access to the abdominal cavity [3,25]. ...
... Untwisting the stomach and repair of secondary defects such as hiatus hernia have been treated successfully using a laparoscopic approach. Performing antireflux surgery in the same sitting, when repairing the paraesophageal defect, may be attempted [23,24]. In a case series of 29 patients who presented with acute gastric volvulus, 13 underwent laparoscopic surgery with 2 conversions to open surgery, another 13 underwent open surgery, and 3 were treated conservatively. ...
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.
... 12 However, regardless of surgeons' preferences, the optimal management of these patients relies on surgical principles of critical importance, such as volvulus reduction, hernial sac excision, diaphragmatic crura reapproximation, and reestablishment of an antireflux mechanism in selected patients. 13 With these key steps in mind and when patient's clinical health status allows, the laparoscopic approach stands for a valuable alternative for the treatment of acute gastric volvulus, 14 as described by some authors. 15 However, due to the rarity of this condition, data comparing laparoscopy to open is still scant. ...
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 the treatment of acute gastric volvulus. Yet, more data focusing on patients' postoperative quality of life (QoL) is needed. The aim of this study is to report our institutional experience with the management of acute gastric volvulus, assessing surgical outcomes and postoperative QoL.
Materials and Methods: We performed a retrospective review of a prospectively maintained database, looking for patients with gastric volvulus, requiring emergency laparotomic or laparoscopic surgery, between 2016 and 2018. Follow-up included clinical evaluation, barium swallow X-ray, and two QoL questionnaires-Gastroesophageal Reflux Disease-Health-Related Quality of Life and Gastrointestinal Symptom Rating Scale.
Results: Over a 3-year period, 9 patients underwent emergency surgery for acute gastric volvulus, 5 (55%) of which were performed laparoscopically. In this group, the only postoperative complication was found in 1 (20%) patient who presented mild delayed gastric empty. In the laparotomic group, 3 patients (75%) had immediate (30-day) postoperative complications-1 pneumonia, 1 bowel obstruction, and 1 sepsis with mul-tiorgan failure. At a median follow-up of 25 (15-48) months, hiatal hernia recurred in 1 (20%) patient after laparoscopic repair. No recurrence occurred in the open group. With a 100% response rate, QoL questionnaires revealed that 80% of the subjects treated laparoscopically were fully satisfied of the surgical approach, reporting slightly better QoL scores than the open surgery group.
Conclusions: Improved postoperative clinical outcomes and QoL after laparoscopic repair of acute gastric volvulus provide encouraging evidence in support of this minimally invasive approach as an alternative to laparotomy.
... 1 The incidence is not well defined in the literature because it is associated with gastric volvulus secondary to hiatal hernia. 2 The primary volvulus is described as those with flaccidity of stomach ligaments and secondary ones related to the presence of large hiatal hernias. [3][4][5] The high morbidity and mortality associated with gastric volvulus requires immediate diagnosis and treatment, especially in acute cases, in which the reported mortality is up to 56%. 6 In chronic forms, the mortality rate varies from 0 to 13%. 7 Gastric perforation resulting from parietal ischemia can occur in 5 -28% of patients with organoaxial volvulus. 8 Prior to 1993, there was no report of gastric volvulus laparoscopic treatment in the literature. ...
... 9 The laparoscopic approach had its first report in 2003, with increasing relevance due to the comorbidities inherent to older patients and the operative risk. 3,10 This study aimed to report the experience acquired in the evaluation, treatment, and results of the surgical treatment of gastric volvulus by video-laparoscopy. ...
Background:
Gastric volvulus is a rare condition, characterized by abnormal rotation of the stomach, causing obstruction with risk of ischemia, necrosis, and perforation. It is associated with high morbidity and mortality rates and, as it is life threatening, early diagnosis and treatment are crucial.
Methods:
Retrospective study of medical records of intrathoracic gastric volvulus patients treated by video-laparoscopy from January 2000 to December 2018, in a University Hospital.
Results:
Thirty patients (34 surgical procedures - 4 re-operations), 9 (30%) male and 21 (70%) female. The mean age was 57.65 ± 32.65 and the mean body mass index was 27.11 ± 3.5 kg/m2. The most prevalent symptoms were epigastric pain and dysphagia. In 41.17% of the cases, the contrast X-ray confirmed the diagnosis. All 34 cases were intrathoracic volvulus, 24 of which were organo-axial (70.58%). The surgical technique used was hiatoplasty, without mesh (25 cases; 73.52%) and with reinforcement mesh (9 cases; 26.47%), mostly associated with Nissen fundoplication (52.94%). The mean surgical time was 215.7 ± 62.9 minutes, with conversion in 5 cases (15.62%). Hospitalization ranged from 4 ± 2 days. There was no record of operative mortality, and symptom improvement occurred in 100% of patients. The mean follow-up time for patients was 41.8 ± 32.6 months.
Conclusions:
Surgical treatment should be indicated to reduce morbidity and mortality, and associated with improved symptoms and patient prognosis. Video-laparoscopic surgery on intrathoracic gastric volvulus proved to be safe and effective and should be the option of choice in the management of this disease.
