Acute gastric volvulus consisting of torsion of the stomach of more than 180℃with closed loop obstruction and possible strangulation continues to challenge surgeons, which is a rare disease and usually develops as a complication in diaphragmatic
hernia
or diaphragmatic defect.
The etiology of gastric volvulus is divided two types; primary and secondary, primary volvulus occurs spontaneously without any other organ derangement and secondary volvulus occure after herniation of the stomach through a diaphragmatic defect.
According to topographic anatomic configuration, torsion occurs about the longitudinal axis of the stomach(organoaxial or cardiopyloric axis) in approximately two-thirds of the cases and about the vertical axis(mesenteroaxial) in one-third.
Severe obstruction or epigastric pain along with inability to swallow food or fluid is the most common presenting complaint of the patients, but some patients maybe asymptomatic or complaint mild gastrointestinal vague symptoms for several years.
Sometimes, acute gastric volvulus maybe precipitated by heavy lifting, rapid ingestion of large amount of meal, effervescent drinks, trauma or severe exercises.
Roentgen examination of the chest is the most important diagnostic aid. And the upper gastrointestinal contrast medium studies may be very helpful to confirm the diagnosis.
Because of the danger of strangulation, emergent operation is required as soon as possible affer the final diagnosis is made.
4 cases of gastric volvulus complicated in diaphragmatic hernia were treated surgically at ST. Mary's Hospital, and all of the patients were good in prognosis postoperatively. The autors report with a review of literatures.
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