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Surgery - Gastric Volvulus
Indications
The abnormal rotation of all or part of the stomach above 180 degrees, known as gastric volvulus, can cause blockage. Based on the axis of rotation, they can be categorized as subdiaphragmatic (1/3) or supradiaphragmatic (2 /3, linked to diaphragmatic defects):
Mesenteroaxial: Rotation along an axis perpendicular to its longitudinal axis; Organoaxial: Rotation along a longitudinal axis via the gastroesophageal junction and the stomach.
Combination types are possible.
Etiology
Abnormal laxity of the gastrosplenic, gastroduodenal, gastrohepatic, and gastrophrenic ligaments is referred to as subdiaphragmatic (more prevalent in adults).
Supradiaphragmatic: Paraoesophageal hernia; congenital or acquired anatomical defects of the diaphragm.
Epidemiology
The most prevalent kind is organoaxial; mixed occurrences are uncommon. Children, typically under a year old, account for ten to twenty percent of instances. Seldom seen in adults under 50.
History
Severe epigastric or chest pain, ineffective retching, and rarely hemomatemesis or respiratory difficulty are the emergency symptoms of acute volvulus. Chronic volvulus: in children, feeding difficulties and stunted growth; epigastric pain and fullness after meals.
Examination
discomfort and distention in the upper abdomen.
The trio of Borchardt syndrome is pain, retching, and difficulty passing a nasogastric tube.
Investigations
CXR: If intrathoracic, a gas bubble appears behind the heart.
AXR: A highly enlarged viscus gas shadow.
Acute case diagnosis via barium swallowing or CT scanning.
Management
General: Nasogastric decompression trial and resuscitation. Although it is controversial, endoscopic reduction can be tried as a temporary solution for patients who are at high risk of surgery.
Surgical: Volvulus reduction, either open or laparoscopic. The viability of the stomach is evaluated, and if gangrenous, a partial, subtotal, or total gastrectomy may be necessary.
Anterior gastropexy is done in conjunction with the repair of any related diaphragmatic defect in order to prevent recurrence.
Complications
Vascular compromise include ulceration, bleeding, perforation, and strangling and necrosis.
Prognosis
The high non-operative death rate is typically caused by a delayed diagnosis, particularly in cases of acute presentations. With proper care, mortality is currently less than 16%.
Indications
The abnormal rotation of all or part of the stomach above 180 degrees, known as gastric volvulus, can cause blockage. Based on the axis of rotation, they can be categorized as subdiaphragmatic (1/3) or supradiaphragmatic (2 /3, linked to diaphragmatic defects):
Mesenteroaxial: Rotation along an axis perpendicular to its longitudinal axis; Organoaxial: Rotation along a longitudinal axis via the gastroesophageal junction and the stomach.
Combination types are possible.
Etiology
Abnormal laxity of the gastrosplenic, gastroduodenal, gastrohepatic, and gastrophrenic ligaments is referred to as subdiaphragmatic (more prevalent in adults).
Supradiaphragmatic: Paraoesophageal hernia; congenital or acquired anatomical defects of the diaphragm.
Epidemiology
The most prevalent kind is organoaxial; mixed occurrences are uncommon. Children, typically under a year old, account for ten to twenty percent of instances. Seldom seen in adults under 50.
History
Severe epigastric or chest pain, ineffective retching, and rarely hemomatemesis or respiratory difficulty are the emergency symptoms of acute volvulus. Chronic volvulus: in children, feeding difficulties and stunted growth; epigastric pain and fullness after meals.
Examination
discomfort and distention in the upper abdomen.
The trio of Borchardt syndrome is pain, retching, and difficulty passing a nasogastric tube.
Investigations
CXR: If intrathoracic, a gas bubble appears behind the heart.
AXR: A highly enlarged viscus gas shadow.
Acute case diagnosis via barium swallowing or CT scanning.
Management
General: Nasogastric decompression trial and resuscitation. Although it is controversial, endoscopic reduction can be tried as a temporary solution for patients who are at high risk of surgery.
Surgical: Volvulus reduction, either open or laparoscopic. The viability of the stomach is evaluated, and if gangrenous, a partial, subtotal, or total gastrectomy may be necessary.
Anterior gastropexy is done in conjunction with the repair of any related diaphragmatic defect in order to prevent recurrence.
Complications
Vascular compromise include ulceration, bleeding, perforation, and strangling and necrosis.
Prognosis
The high non-operative death rate is typically caused by a delayed diagnosis, particularly in cases of acute presentations. With proper care, mortality is currently less than 16%.
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