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KMID : 0360719940070010062
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Journal of the Korean Society Traumatology
1994 Volume.7 No. 1 p.62 ~ p.67
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A Case of Chronic Gastric Volvulus Complicated in Traumatic Diaphragmatic Herni
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김선영/Kim, Sung Young
구영무/조무식/송재화/안철용/Koo, Young Moo/Cho, Moo Sik/song, Jae Wha/Ahn, Chul Yong
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Abstract
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A clinical review was made on a case of chronic gastric volvulus with previous traumatic diaphragmatic hernia which was operated upon the Department of General Surgery, Soon Chun Hyang University Hospital, Chun An, Korea, on March, 1994.
Gastric volvulus is a rare disease defined as torsion of the stomach of more than .180° with closed loop obstruction, which usually combined with idiopathic or secondary diaphragmatic hernia, eventration of diaphragm, hiatal hernia.
Gastric volvulus may occur at any age, especially fifth decade and the incidence is approximately the same in both sexes.
Acute volvulus presents a striking clinical picture first described in 1904 by Borchardt, who emphasized the following three features.
1. Severe epigastric pain and distension.
2. Vomiting followed by violent retching with an inability to vomit. 3. Difficulty or inability to pass a nasogastric tube.
Chronic volvulus may be symptomless and an incidental finding on a--barium enema or chest x-ray film. When symptoms occur, they are frequently those of mild, continuous or intermittent upper abdominal discomfort that may be impossible to differentiate from peptic ulcer, calculous disease of gallbladder.
Most cases of total gastric volvulus are organoaxial, as are the majority of acute case and this type is usually associated with diaphragmatic hernia of eventration. In contrast, the mesenteroaxial type is more often idiopathic and partial in extent, chronic volvulus.
Acute volvulus can somtimes be reduced by the passage of nasogastric tube but in most cases it cannot be passed, and immediate operation will be required. If primary
volvulus has no obvious cause, gastropexy must be considered by taking the anterior wall of the stomach to the parietal peritoneum. If gastric necrosis has taken place, local excision, subtotal gastrectomy or total gastrectomy will be required, depending on the extent of the ischemic injury.
A case of chronic, organoaxial and mesenteroaxial gastric volvulus complicated traumatic diaphragmatic hernia was treated surgically by primary repair of diaphragmatic defect and gastropexy, and the patient was good prognosis postoperatively. The authors report with a review of literatures.
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