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[Chronic volvulus of the stomach].

An acute gastric volvulus calls for an urgent operation, while a chronic volvulus can be indicated for operation only after a careful clinical and paraclinical examination which rules out other causes of the symptoms. The authors describe a case of secondary gastric volvulus successfully treated by a causal surgical operation involving elimination of adhesions without gastropexy.

Adult↗

Organo-axial volvulus of the stomach with diaphragmatic eventration.

Gastric volvulus occurs when the stomach rotates about its longitudinal axis (organo-axial volvulus), or about an axis joining the lesser and greater curvatures (mesentero-axial volvulus). Primary gastric volvulus, making up one third of cases, occurs when the stabilizing ligaments are too lax as a result of congenital or acquired causes. Secondary gastric volvulus, making up the remainder of cases, occurs in association with a paraesophageal hernia or other congenital or acquired diaphragmatic defects. While gastric volvulus may occur acutely, especially in children, it may not be clinically apparent and discovered incidentally. The authors present a case of chronic organo-axial volvulus of the stomach secondary to left hemidiaphragmatic eventration with a review of the relevant literature.

Adult↗

Antral infracolic volvulus of the stomach.

Two cases of antral infracolic volvulus of the stomach are presented. The etiology of gastric volvulus and the difference between the organo-axial and mesentero-axial volvulus are discussed. Further subdivision into partial or complete volvulus and the relationship between the transverse colon and the stomach during gastric volvulus is emphasized. Awareness and understanding of gastric volvulus may allow roentgen diagnosis.

Adult↗

[A case of Bochdalek hernia in an adult with volvulus of the stomach and hypopotassemia].

Gastric volvulus is a rare disease. We recently encountered a gastric volvulus associated with Bochdalek hernia and severe hypopotassemia. A 32-year-old woman experienced epigastric pain and recurrent vomiting. The changes of the electrocardiogram in this patient (K1.8mEq/l) were inverted T wave and ST depression. She was diagnosed as having gastric volvulus associated with Bochdalek hernia by chest X-ray films, contrast radiography of the upper digestive tract and thoraco-abdominal CT scans. Symptoms did not disappear with the administration of conservative therapy. At laparotomy, the stomach was rotated around its mesenteric axis in the sagittal plane. After operative repair, symptoms disappeared, and serum potassium level returned to normal. Gastric volvulus is rather easily diagnosed if its existence is kept in mind.

Adult↗

Hiatus hernia and reflux esophagitis.

Usually, axial hiatus hernia is a common disorder that produces no symptoms and requires no treatment and in the few patients who do experience symptoms, simple nonoperative treatment measures suffice. The typical symptoms of reflux esophagitis are heartburn and nocturnal regurgitation. Most patients respond well to nonoperative treatment; any associated axial hiatus hernia is not the cause of the symptoms of reflux esophagitis and does not need treatment. In the very few patients who do need an operation, fundoplication conducted through the abdomen is recommended. In nonaxial hiatus hernia the symptoms of intermittent obstruction and bleeding are due to volvulus of the herniated stomach; volvulus produces a closed-loop obstruction, a potentially dangerous condition. Surgical repair should be undertaken when the diagnosis is made, just as for other hernias of the abdominal wall and for the same cogent reasons. Prosthetic reinforced repair conducted through the abdomen is preferred.

Diagnosis, Differential↗

Endoscopic management of chronic organoaxial volvulus of the stomach.

Endoscopic correction of the chronic organoaxial volvulus of the stomach was attempted in seven cases of primary and three cases of secondary volvulus. Endoscopic correction was successful in six cases of primary volvulus and one case of volvulus secondary to duodenal carcinoma. This paper describes the details of the technique of endoscopic correction of gastric volvulus, and documentation of correction of the volvulus by barium meal study with a follow-up of 5-26 months.

Adult↗

Gastric volvulus and the upside-down stomach.

Gastric volvulus may present acutely with Borchardt's triad or with chronic vague abdominal symptoms. Predisposing factors include lax ligaments, bands, adhesions, paraesophageal diaphragmatic hiatus hernia, and eventration of the diaphragm. The goals of surgery are to detorse the stomach, correct conditions associated with volvulus and prevent a recurrence. Anterior gastropexy with or without colon displacement is mandatory. Gastric resection may be required for strangulation and necrosis.

Chronic Disease↗