Gastric Volvulus

Abstract

Gastric volvulus consists in the rotation of at least 180° of the stomach on itself, resulting in partial or total foregut obstruction. It can be classified in several ways: on the basis of the axis on which the rotation takes places, it is termed organoaxial, mesentericoaxial, or mixed; based on the etiology, it can be primary or secondary; depending on its location, it is abdominal or intrathoracic. On the basis of its mode of presentation, it may be acute or chronic. Clinical symptoms of infants and children with gastric volvulus are nonspecific and depend on the degrees of rotation and obstruction, but radiological findings are characteristic, and the diagnosis is usually performed by upper gastrointestinal contrast evaluation. Acute gastric volvulus is a surgical emergency, because it can be life-threatening for children; the goals of operative treatment are volvulus reduction, recurrence prevention, and associated anomaly correction. Conservative management is advocated in patients with intermittent or chronic volvulus, the most frequent form in pediatric age, although the worsening of the symptoms or their persistence resulting in failure to thrive are indications of the surgical approach.