Gastric volvulus

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MINISTERY OF HIGHIER EDUCATIONBOST
UNIVERSITYGastric volvulus

• Lecturer- Dr. Aman ullah durrani
• Prepared by- MUHAMMAD AMIN MUBARIZ

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TABLE OF CONTENT

1. Definition of volvulus
2. Classification of volvulus
3. Causes of volvulus
4. Diagnosis of volvulus
5. Complications of volvulus
6. Reference

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Volvulus
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Volvulus

• Volvulus occurs when an air-filled segment of the
  colon twists about its mesentery.
• Sigmoid colon is involved in up to 90 of cases,
  but volvulus can involve the cecum (lt20) or
  transverse colon.
• Volvulus may reduce spontaneously, but more
  commonly produces bowel obstruction.
• Chronic constipation may produce a large,
  redundant colon (chronic megacolon) that
  predisposes to volvulus
• Symptoms abdominal distention, nausea, and
  vomiting.
• Symptoms rapidly progress to generalized
  abdominal pain and tenderness.
• Fever and leucocytosis are heralds of gangrene
  and/or perforation.

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Gastric volvulus

• Idiopathic (Type 1)
  (65)
• Secondary (Type 2)
  (35)
• Hiatus hernia
• Left sided eventration
• Adhesions
• Pyloric obstruction with long-standing gastric
  dilatation.

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Gastric volvulus

• Gastric volvulus or volvulus of stomach is a
  twisting of all or part of the stomach.
• by more than 180 degrees with obstruction of the
  flow of material through the stomach.
• variable loss of blood supply and possible
  tissue death.

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Gastric volvulus

• The twisting can occur around the long axis of
  the stomach this is called organoaxial
• or around the axis perpendicular to this, called
  mesenteroaxial.
• Obstruction is more likely in organoaxial
  twisting than with mesenteroaxial while the
  latter is more associated with ischemia.
• About one third of the cases are associated with
  a hiatus hernia..

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classic triad (Borchardt's Triad)

• The classic triad (Borchardt's Triad) of gastric
  volvulus,
• described by Borchardt in 1904,
• consists of severe epigastric pain,
• retching (due to sour taste in mouth) without
  vomiting,
• inability to pass a nasogastric tube and
  reportedly occurs in 70 of cases
• Sometimes severe pain at the top of left
  shoulder, this may be due to internal bleeding
  irritating the diaphragm upon respiration.

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Classification

• Organoaxial type
• Mesenteroaxial type
• Combined type

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Organoaxial type

• In an organoaxial gastric volvulus, the stomach
  rotates around an axis that connects the
  gastroesophageal junction and the pylorus.
• The antrum rotates in opposite direction to the
  fundus of the stomach.
• This is the most common type of gastric
  volvulus, occurring in approximately 59 of cases
• and it is usually associated with diaphragmatic
  defects.
• Strangulation and necrosis commonly occur with
  organoaxial gastric volvulus and have been
  reported in 528 of cases.
• The key imaging feature of organoaxial volvulus
  is that the greater curvature is located above
  the lesser curvature of the stomach

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Mesenteroaxial type

• The mesenteroaxial axis bisects the lesser and
  greater curvatures.
• The antrum rotates anteriorly and superiorly so
  that the posterior surface of the stomach lies
  anteriorly.
• The rotation is usually incomplete and occurs
  intermittently.
• Vascular compromise is uncommon.
• This cause comprises approximately 29 of cases
  of gastric volvulus.
• The key imaging feature of mesenteroaxial
  volvulus is that the antrum is above the
  gastroesophageal junction.

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Combined type

• The combined type of gastric volvulus is a rare.
• the stomach twists mesentericoaxially and
  organoaxially.
• This type of gastric volvulus makes up the
  remainder of cases OR PERCENTAGE.
• and is usually observed in patients with chronic
  volvulus.

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Cause

• Type 1
• Gastric volvulus of unknown cause comprises two
  thirds of cases.
• and is presumably due to abnormal laxity of the
  gastrosplenic, gastroduodenal, gastrophrenic, and
  gastrohepatic ligaments.
• Type 1 gastric volvulus is more common in adults
  but has been reported in children

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Cause

• Type 2
• Type 2 gastric volvulus is found in one third of
  patients.
• and is usually associated with congenital or
  acquired abnormalities
• that result in abnormal mobility of the stomach.

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Diagnosis

• On chest radiography, a retrocardiac, gas-filled
  viscus may be seen in cases of intrathoracic
  stomach, which confirms the diagnosis.
• Plain abdominal radiography reveals a massively
  distended viscus in the upper abdomen.
• In organoaxial volvulus, plain films may show a
  horizontally oriented stomach with a single
  air-fluid level and a paucity of distal gas.
• In mesenteroaxial volvulus, plain abdominal
  radiographic findings include a spherical stomach
  on supine images and 2 air-fluid levels on erect
  images, with the antrum positioned superior to
  the fundus.

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Endoscopy

• Upper gastrointestinal (GI) endoscopy may be
  helpful in the diagnosis of gastric volvulus.
• When this procedure reveals distortion of the
  gastric anatomy with difficulty intubating the
  stomach or pylorus, it can be highly suggestive
  of gastric volvulus.
• In the late stage of gastric volvulus,
  strangulation of the blood supply can result in
  progressive ischemic ulceration or mucosal
  fissuring.

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Complication

• Perforation
• Gangrene of stomach
• bleeding

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Reference

• https//www.uptodate.com
• www.wikipedia of gastric volvulus