GASTRIC VOLVULUS
Description
• Patient: man, age 68
• Previous medical history includes hypertension, four years of chronic pancreatitis, and a total knee replacement with • • revision on the left knee three weeks ago.
• Setting: Postoperative rehabilitation in a nursing home
◉ Presenting complaints
• One day's worth of distension, widespread stomach pain, and epigastric pain
• Constipation and flatus for eight days
• Belching, retching, and progressive distension of the abdomen for two days
• No fever or vomiting
◉ preliminary results
• An enlarged stomach with an NG tube wound in the esophagus is seen on the X-ray.
• CT scan: Significant distension of the stomach, absence of air or fluid
• Vitals: stable; SpO₂ 97%, HR 97/min, and BP 132/75 mmHg
• Soft, slightly enlarged, and not sensitive is the abdomen.
◉ Investigations
• Lab results: normal electrolytes, mild anemia (Hb 10.5 g/dL), and mild leukocytosis (WBC 12.8 K/uL).
• Following NG progress, an X-ray revealed ileus.
• Follow-up in the small intestine:
• Mesentero-axial (MA) stomach volvulus was seen.
• Dislocated antrum above the gastroesophageal junction
• Normal small bowel
• An upside-down stomach was confirmed by CT scan, with the antrum and pylorus above the fundus and proximal
body.
◉ Discussion Points
• Definition: More than 180 degrees of stomach rotation → blockage of the inlet or outflow ± strangulation.
• Types (by rotational axis):
• 59% are organo-axial (OA).
• MA (mesentero-axial): 29%
• OA + MA combined: 2%
• 10% is unclassified.
◉ The cause:
• Primary (idiopathic): brought on by aberrant adhesions or ligamentous attachments
• Secondary: brought on by gastric/splenic abnormalities, peptic ulcers, and diaphragmatic hernias
• Rare in the elderly, MA volvulus is frequently idiopathic or the result of diaphragmatic elevation or adhesions.
◉ Clinical features:
• Acute: The Borchardt trio, which includes retching, excruciating epigastric pain, and difficulty passing an NG tube
• Chronic: sporadic or nebulous stomach pain
◉ diagnosis is:
• Simple X-ray: Air-fluid levels, enlarged stomach
• Upper GI series and barium studies are typically diagnostic.
• The most accurate CT scan displays the stomach "upside-down," with the pylorus above the fundus.
Protocol
◉ Management
The first conservative treatment didn't work.
◉ Surgery:
• Verified MA stomach volvulus
• More curvature that adheres to the diaphragm
• Released adhesions, right-side gastropexy, and left-side gastrostomy (G-tube)
• Postoperative course: uneventful; on the fourth postoperative day, they were sent to rehabilitation.
◉ Therapy:
• First: decompression of NG
• The final options are gastropexy ± gastrostomy and surgical derotation.
• Depending on the situation, a laparotomy or laparoscopy may be used.
• Objective: Treat the underlying cause and avoid recurrence.
• Abdominal distension, retching without vomiting, intense epigastric pain, and occasionally constipation or difficulty passing gas are the main symptoms of gastric volvulus acute gastric obstruction.
• This results from an irregular rotation of the stomach, which obstructs the gastric inlet and exit. Vascular compromise in extreme circumstances may lead to perforation, necrosis, or strangling.
• The non-specific symptoms of gastric volvulus might be mistaken for other gastrointestinal issues, which causes delays in diagnosis and increases the risk of consequences including stomach gangrene.
• Complication Risk: There is a considerable chance of developing gastric necrosis, perforation, peritonitis, septic shock, and even death if treatment is not received.
◉ Comprehensive Management Plans for First Stabilization:
• Nasogastric (NG) Decompression: This procedure involves inserting a nasogastric tube to alleviate pressure in the stomach, reduce the risk of aspiration, and prevent increasing ischemia.
• Supportive therapy includes electrolyte monitoring and correction as well as intravenous fluids to restore circulation and treat dehydration.
• Nil Per Os (NPO): To prevent further stomach distension or aspiration risk, the patient should not take any oral medications.
◉ Surgical Management as the Final Treatment:
• The gold standard is surgical correction, particularly when conservative care fails if there are indications of strangulation or perforation.
• This includes removal of any gangrenous tissue that may be present, evaluation of gastric viability, detorsion (untwisting of the stomach), and gastropexy (fixating the stomach to avoid recurrence).
• Placement of a Gastrostomy Tube: For nutritional support and decompression in the event that persistent stomach dysfunction is predicted.
Notes
FOR MORE DETAILS VISIT https://pmc.ncbi.nlm.nih.gov/articles/PMC5947932/?utm_source=chatgpt.com
