Gastric volvulus

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Gastric volvulus

  • 3 types: organoaxial (more common, associated with  diaphragmatic defects), mesenteroaxial (more common in paediatric population, less associated with diaphragmatic defects, more severe obstruction), mixed
    ano-imperforado-j-14-728
    Nnayak-GVtypes
  • Borchadt’s triad:  severe epigastric pain, retching without vomiting and inability to pass NG tube
  • High risk of gastric ischemia and perforation.

Diagnosis

  • UGI series
  • CT
    – Early CT of the abdomen and pelvis is recommended when gastric volvulus is suspected; it will aid in distinguishing this from hiatal hernia.
  • Gastric wall pneumatosis and free fluid in hernia sac = impendic rupture

Management

  • Non-surgical (no clinical and radiographic evidence of gastric strangulation):
    –  Nasogastric or endoscopic decompression with percutaneous gastrostomy may be considered, high recurrence rate as the defect persists and stomach has not been reduced to its anatomical position
  • In stable patients, the stomach is detorsed, and then laparoscopy or laparotomy to repair the diaphragmatic defect with gastropexy
  • In unstable patients, partial gastrectomy is considered.
    – If gastric necrosis happens, often in fundus -> sleeve gastrectomy can be done
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