Acute gastric volvulus symptoms diagnosis and treatment
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Acute Gastric Volvulus Symptoms: Abdominal Pain, Vomiting, and Obstruction
Acute gastric volvulus is a rare but life-threatening condition where the stomach twists on itself, leading to obstruction and possible tissue death. The most common symptoms are sudden and severe abdominal pain, persistent vomiting (often without relief), abdominal distention, and sometimes upper gastrointestinal bleeding or anemia. In both adults and children, vomiting and abdominal pain are the most frequently reported symptoms, with some patients also experiencing constipation or respiratory symptoms due to the stomach pressing on the diaphragm or lungs Ja1993Gourgiotis2006Hung2019+6 MORE. In elderly patients, symptoms can be vague, making diagnosis more challenging Ouaz2025Kilidar2023.
Diagnosis of Acute Gastric Volvulus: Imaging and Clinical Suspicion
Diagnosing acute gastric volvulus requires a high index of suspicion, especially since symptoms can be non-specific. Imaging studies are crucial for confirmation. Computed tomography (CT) scans are considered the gold standard for diagnosis, as they clearly show the abnormal rotation of the stomach and any associated complications like hernias or tissue death Ouaz2025Manzenreiter2025Rashid2009+2 MORE. Chest or abdominal X-rays may reveal a gas-filled stomach in unusual locations, and barium studies or upper gastrointestinal endoscopy can also help identify the obstruction and the type of volvulus (organoaxial or mesenteroaxial) Gourgiotis2006Carter1980Light2016+1 MORE. Prompt imaging is essential, especially when patients present with Borchardt’s triad: severe epigastric pain, unproductive retching, and inability to pass a nasogastric tube .
Treatment of Acute Gastric Volvulus: Emergency Surgery and Gastropexy
Acute gastric volvulus is a surgical emergency. Immediate treatment is necessary to prevent complications such as gastric necrosis, perforation, and sepsis. The first step is often stabilization with nasogastric tube decompression, but this is frequently unsuccessful in relieving the obstruction Ja1993Light2016. Definitive treatment is surgical, with options including open or laparoscopic reduction of the volvulus, repair of any associated hernia or diaphragmatic defect, and fixation of the stomach (gastropexy) to prevent recurrence Ja1993Gourgiotis2006Hung2019+7 MORE. Laparoscopic surgery is increasingly favored due to shorter recovery times and less postoperative pain, though open surgery may be required in cases of tissue death or perforation Hung2019Ouaz2025Light2016+2 MORE. In children, laparoscopic and even single-port surgeries are effective options . Conservative management may be considered in stable patients, but surgery is generally recommended to avoid life-threatening complications .
Conclusion
Acute gastric volvulus is a rare but serious condition that presents with sudden abdominal pain and vomiting. Diagnosis relies on a high level of clinical suspicion and prompt imaging, especially CT scans. Emergency surgical intervention is the mainstay of treatment to prevent severe complications and ensure good outcomes. Early recognition and management are critical for patient survival and recovery Ja1993Gourgiotis2006Hung2019+7 MORE.
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