Gastric Volvulus

Epidemiology

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Diagnosis

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Clinical Manifestations

Acute Gastric Volvulus

Cardiovascular Manifestations

  • Hypovolemia/Hypotension (see Hypotension, [[Hypotension]])

Gastrointestinal Manifestations

  • Abdominal/Gastric Distention (with Stomach Filled with Fluid) with Dullness to Percussion: may occur with complete gastric obstruction
  • Borchardt’s Triad: present in 70% of cases
    • Upper Abdominal Pain/Lower Chest Pain (see Abdominal Pain, [[Abdominal Pain]])
      • Pain may occur due to traction on adjacent structures with resultant pancreatic or omental ischemia, omental avulsion, splenic rupture
    • Inability to Pass Nasogastric Tube
    • Vomiting (see Nausea and Vomiting, [[Nausea and Vomiting]]): vomiting may be severe (and non-productive)
  • Hyperamylasemia/Hyperlipasemia (see Hyperamylasemia, [[Hyperamylasemia]] and Hyperlipasemia, [[Hyperlipasemia]]): due to pancreatic ischemia
  • Gastric Ischemia (see Gastric Ischemia, [[Gastric Ischemia]])
  • Gastric Hemorrhage (see Gastrointestinal Hemorrhage, [[Gastrointestinal Hemorrhage]]): due to mucosal ischemia or mucosal tears associated with vomiting
  • Peritonitis (see Peritonitis, [[Peritonitis]]): may occur in cases with significant gastric ischemia (due to strangulation) or gastric perforation

Hematologic Manifestations

  • Anemia (see Anemia, [[Anemia]]): due to mucosal ulceration/gastrointestinal hemorrhage
  • Leukocytosis (see Leukocytosis, [[Leukocytosis]])

Pulmonary Manifestations

  • Auscultation of Gastric Sounds in the Chest

Chronic Gastric Volvulus

General Comments

  • Symptoms May be Vague and Non-Specific

Gastrointestinal Manifestations

  • Acute Pancreatitis (see Acute Pancreatitis, [[Acute Pancreatitis]]): may occur occasionally
  • Bloating: however, abdominal distention may be minimal (as stomach is often located in the chest)
  • Dysphagia (see Dysphagia, [[Dysphagia]])
  • Gastric Ulceration/Low-Grade Gastric Hemorrhage (see Gastrointestinal Hemorrhage, [[Gastrointestinal Hemorrhage]])
  • Heartburn/Dyspepsia (see Dyspepsia, [[Dyspepsia]])
  • Hyperamylasemia/Hyperlipasemia (see Hyperamylasemia, [[Hyperamylasemia]] and Hyperlipasemia, [[Hyperlipasemia]]): due to pancreatic ischemia
  • Mild Upper Abdominal Discomfort (see Abdominal Pain, [[Abdominal Pain]]): may be absent

Hematologic Manifestations

  • Anemia (see Anemia, [[Anemia]]): due to mucosal ulceration/gastrointestinal hemorrhage

Treatment

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References

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