Gastric Volvulus

Gastric volvulus

Gastric volvulus is a surgical emergency in which the stomach rotates on itself, producing variable degrees of mechanical obstruction and, if prolonged, vascular compromise with ischaemia, necrosis and perforation. Although uncommon, delays in recognition and definitive treatment markedly increase morbidity and mortality. Early identification in the emergency department and prompt surgical review are mandatory.

Overview

• Mechanism: torsion of the stomach around one of its axes leading to closed‑loop obstruction, progressive distension, venous congestion and possible arterial compromise.
• Clinical importance: sustained torsion may produce full‑thickness gastric necrosis and perforation; time‑sensitive escalation to definitive care is required.

Epidemiology and aetiology

• Occurs in children and adults; the aetiology differs by age group.
• Adults: commonly associated with loss or laxity of gastric supporting ligaments, large para‑oesophageal hernias or other diaphragmatic defects, prior thoraco‑abdominal surgery, trauma or mass effect.
• Children: often primary (congenital ligamentous laxity) or associated with congenital diaphragmatic anomalies.

Pathophysiology and classification

• Harm arises from mechanical obstruction (inflow/outflow) causing acute distension → raised intragastric pressure → venous outflow obstruction → ischaemia → possible transmural infarction and perforation.
• Classified by axis of rotation:
• Organoaxial: rotation about the long axis between cardia and pylorus. This is the most common type in adults, frequently associated with para‑oesophageal hernia, and more likely to present acutely with obstruction and ischaemia.