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
  
  
• 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