Management of Acute Gastric Volvulus

Abstract

Acute gastric volvulus is a relatively rare, but serious, surgical emergency defined as rotation of the stomach greater than 180 °. This leads to foregut luminal obstruction and compromised blood flow to the stomach with ischemia and potentially necrosis. Treatment is initiated with gastric decompression via a nasogastric tube or endoscopic decompression. Definitive surgical management includes reduction of the volvulized stomach, resection of gastric necrosis if present, and gastropexy. A high index of suspicion is necessary to ensure a prompt work-up and intervention. If diagnosis and treatment are significantly delayed, morbidity and mortality rates can be high. This is related to the fact that the cohort of patients likely to be affected by this phenomenon is typically the elderly and often frail with decreased physiologic reserve to tolerate such an insult.