Gastric volvulus in adults
- Jon O Wee, MD
Jon O Wee, MD
- Instructor in Surgery
- Harvard Medical School
Gastric volvulus is characterized by rotation of the stomach along its long or short axis leading to variable degrees of gastric outlet obstruction, which may present acutely, or chronically. Rotation of the stomach more than 180° causes complete gastric outlet obstruction, and potentially strangulation of the stomach leading to ischemia, and potentially necrosis, perforation, and abdominal sepsis. Mortality related to acute gastric volvulus is high if unrecognized, underscoring the need for early diagnosis and treatment [1-4].
The classification, clinical manifestations, diagnosis, and treatment of gastric volvulus will be reviewed here. General considerations for gastric outlet obstruction are discussed elsewhere. (See "Gastric outlet obstruction in adults".)
EPIDEMIOLOGY AND RISK FACTORS
Gastric volvulus is rare. The incidence peaks after the fifth decade with adults constituting 80 to 90 percent of cases . No association with sex or race has been reported.
Risk factors — Risk factors for gastric volvulus in adults include the following :
●Age >50 years
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- EPIDEMIOLOGY AND RISK FACTORS
- Risk factors
- Primary versus secondary gastric volvulus
- Axis of rotation
- Acute versus chronic gastric volvulus
- CLINICAL PRESENTATIONS
- Acute gastric volvulus
- Chronic gastric volvulus
- Acute symptoms
- Chronic symptoms
- DIFFERENTIAL DIAGNOSIS
- INITIAL MANAGEMENT
- Gastric decompression
- APPROACH TO TREATMENT
- Acute gastric volvulus
- Chronic gastric volvulus
- TREATMENT OPTIONS
- Endoscopic de-rotation and PEG tube gastric fixation
- - Open versus laparoscopic repair
- - Techniques
- SUMMARY AND RECOMMENDATIONS