What are the symptoms if acute gastric volvulus? And what is the work up and treatments
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Symptoms, Work-Up, and Treatments of Acute Gastric Volvulus
Symptoms of Acute Gastric Volvulus
Borchardt Triad Symptoms: Acute gastric volvulus is often characterized by the Borchardt triad, which includes severe upper abdominal pain, vomiting, and difficulty passing a nasogastric tube . These symptoms are critical indicators and should prompt immediate medical attention.
Additional Symptoms: Other symptoms can include epigastric distention, nonproductive retching, and upper gastrointestinal bleeding or anemia . In some cases, patients may also present with chest pain, which can be mistaken for cardiac issues.
Diagnostic Work-Up for Acute Gastric Volvulus
Imaging Studies: The diagnosis of acute gastric volvulus is primarily confirmed through imaging studies. A gastrointestinal barium series and CT scans are particularly useful in visualizing the abnormal rotation of the stomach . Upper gastrointestinal endoscopy can also aid in diagnosis by providing direct visualization of the stomach's condition.
Radiographic Indicators: Radiographic studies may show a distended gastric bubble and signs of gastric necrosis, which are critical for diagnosing the severity of the volvulus . These imaging techniques are essential for differentiating gastric volvulus from other abdominal pathologies.
Treatment Options for Acute Gastric Volvulus
Initial Management: Initial treatment often involves gastric decompression using a nasogastric tube or endoscopic methods to relieve distention and reduce the risk of ischemia and necrosis . However, these methods may not always be successful, necessitating further intervention.
Surgical Intervention: Definitive treatment for acute gastric volvulus is surgical. The primary surgical procedures include reduction of the volvulized stomach and gastropexy, which involves fixing the stomach to prevent recurrence . In cases where gastric necrosis is present, gastric resection may be required .
Laparoscopic Approach: Laparoscopic reduction and anterior gastropexy are increasingly being used due to their minimally invasive nature, which is particularly beneficial for high-risk and elderly patients . This approach has been shown to be safe and effective, with a good postoperative outcome.
Postoperative Care: Postoperative care is crucial for recovery. Patients typically have a short hospital stay and experience minimal complications when treated promptly and effectively. Regular follow-up is necessary to monitor for any signs of recurrence or complications.
Conclusion
Acute gastric volvulus is a rare but life-threatening condition that requires prompt diagnosis and treatment. The Borchardt triad of symptoms—severe upper abdominal pain, vomiting, and difficulty passing a nasogastric tube—are key indicators. Imaging studies such as barium series and CT scans are essential for diagnosis. Initial management involves gastric decompression, but definitive treatment is surgical, with laparoscopic reduction and gastropexy being effective options. Early intervention and appropriate surgical management are critical for a favorable outcome.
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