The treatment of gastric volvulus

Abstract

Case 1 was a 79-year old man, who on CT was found to have a gastric volvulus. Decompression with a gastric tube was successful. However, on endoscopy, ischemic changes were found in the stomach. Thus, a total gastrectomy was emergently performed ; during surgery, a mesenteroaxial gastric volvulus was observed.
Case 2 was a 79-year old woman, who on CT was found to have a gastric volvulus. Decompression with a gastric tube was successful. No ischemic changes were noted in the stomach on endoscopy ; however, endoscopic repositioning of the gastric volvulus was unsuccessful. Thus, emergent operation was performed, in which the mesenteroaxial gastric volvulus and an incarceration into a hiatal herniation were found ; the stomach was repositioned.
In general, CT is useful for diagnosing gastric volvulus. With respect to treatment, after decompression with a gastric tube, endoscopy should be performed to identity ischemic changes and to endoscopically reposition the volvulus. If ischemic changes are observed, or endoscopic repositioning is unsuccessful, emergent operation should be performed.
Gastric volvulus is rare. The treatment algorithm described above is useful for achieving a successful result.