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The threatened stomach: management of the acute gastric volvulus.
Surg Endosc. 2016 05; 30(5):1847-52.SE

Abstract

INTRODUCTION

Acute presentation of gastric volvulus is a rare condition with a high mortality for acute ischaemia. This study was undertaken to investigate the acute management, diagnosis, and long-term outcomes of patients presenting with acute gastric volvulus.

METHODS

Cases were reviewed retrospectively from 2004 to 2014. Patients presenting as an emergency admission with acute gastric volvulus were included.

RESULTS

Thirty-six patients were included, five of whom had previous surgery. The mean age was 71 years old. All patients presented with vomiting and chest/epigastric pain. CT was diagnostic in all 26 patients. Barium swallow was diagnostic in two/four patients. OGD was diagnostic in 9 of 20 patients. All patients had an NG tube placed, and eight patients were treated conservatively and made a full recovery. Twenty-nine patients proceeded to surgery. Nine had a laparoscopic repair with two open conversions. Four patients had gastric necrosis, and all had open surgery with resection. Three patients had a mediastinal perforation, and one patient required an additional thoracotomy. All patients with viable stomach had a hiatal repair (where appropriate), 11 had a gastropexy, and 11 had a fundoplication. Mortality for gastric necrosis/perforation was 30 %. Mean postoperative stay was 4 days for laparoscopic repair and 8 days for uncomplicated open surgery. Nine of twenty-nine had transient dysphagia postoperatively. Three of eight patients treated conservatively had an elective procedure subsequently.

CONCLUSIONS

Acute paraoesophageal hiatus hernia requires early resuscitation and diagnosis. CT should be favoured in assessment, and an NG tube placed promptly. A conservative management may be considered safely in stable patients. Surgical management should be prompt for unstable patients. Gastric ischaemia or perforation has a mortality of 30 %. Laparoscopic repair has a shorter postoperative stay, but has a higher recurrence rate. Surgery for patients without gastric ischaemia has good long-term outcomes with minimal morbidity.

Authors+Show Affiliations

Northern Oesophago-Gastric Unit, Royal Victoria Infirmary, Newcastle upon Tyne, NE1 4LP, England, UK. Duncan.light@hotmail.co.uk.Northern Oesophago-Gastric Unit, Royal Victoria Infirmary, Newcastle upon Tyne, NE1 4LP, England, UK.Northern Oesophago-Gastric Unit, Royal Victoria Infirmary, Newcastle upon Tyne, NE1 4LP, England, UK.

Pub Type(s)

Evaluation Study
Journal Article

Language

eng

PubMed ID

26275540

Citation

Light, D, et al. "The Threatened Stomach: Management of the Acute Gastric Volvulus." Surgical Endoscopy, vol. 30, no. 5, 2016, pp. 1847-52.
Light D, Links D, Griffin M. The threatened stomach: management of the acute gastric volvulus. Surg Endosc. 2016;30(5):1847-52.
Light, D., Links, D., & Griffin, M. (2016). The threatened stomach: management of the acute gastric volvulus. Surgical Endoscopy, 30(5), 1847-52. https://doi.org/10.1007/s00464-015-4425-1
Light D, Links D, Griffin M. The Threatened Stomach: Management of the Acute Gastric Volvulus. Surg Endosc. 2016;30(5):1847-52. PubMed PMID: 26275540.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The threatened stomach: management of the acute gastric volvulus. AU - Light,D, AU - Links,D, AU - Griffin,M, Y1 - 2015/08/15/ PY - 2015/03/17/received PY - 2015/07/08/accepted PY - 2015/8/16/entrez PY - 2015/8/16/pubmed PY - 2017/5/27/medline KW - Digestive KW - GORD/GERD (gastro-oesophageal reflux disease) KW - Radiology SP - 1847 EP - 52 JF - Surgical endoscopy JO - Surg Endosc VL - 30 IS - 5 N2 - INTRODUCTION: Acute presentation of gastric volvulus is a rare condition with a high mortality for acute ischaemia. This study was undertaken to investigate the acute management, diagnosis, and long-term outcomes of patients presenting with acute gastric volvulus. METHODS: Cases were reviewed retrospectively from 2004 to 2014. Patients presenting as an emergency admission with acute gastric volvulus were included. RESULTS: Thirty-six patients were included, five of whom had previous surgery. The mean age was 71 years old. All patients presented with vomiting and chest/epigastric pain. CT was diagnostic in all 26 patients. Barium swallow was diagnostic in two/four patients. OGD was diagnostic in 9 of 20 patients. All patients had an NG tube placed, and eight patients were treated conservatively and made a full recovery. Twenty-nine patients proceeded to surgery. Nine had a laparoscopic repair with two open conversions. Four patients had gastric necrosis, and all had open surgery with resection. Three patients had a mediastinal perforation, and one patient required an additional thoracotomy. All patients with viable stomach had a hiatal repair (where appropriate), 11 had a gastropexy, and 11 had a fundoplication. Mortality for gastric necrosis/perforation was 30 %. Mean postoperative stay was 4 days for laparoscopic repair and 8 days for uncomplicated open surgery. Nine of twenty-nine had transient dysphagia postoperatively. Three of eight patients treated conservatively had an elective procedure subsequently. CONCLUSIONS: Acute paraoesophageal hiatus hernia requires early resuscitation and diagnosis. CT should be favoured in assessment, and an NG tube placed promptly. A conservative management may be considered safely in stable patients. Surgical management should be prompt for unstable patients. Gastric ischaemia or perforation has a mortality of 30 %. Laparoscopic repair has a shorter postoperative stay, but has a higher recurrence rate. Surgery for patients without gastric ischaemia has good long-term outcomes with minimal morbidity. SN - 1432-2218 UR - https://www.unboundmedicine.com/medline/citation/26275540/The_threatened_stomach:_management_of_the_acute_gastric_volvulus_ L2 - https://doi.org/10.1007/s00464-015-4425-1 DB - PRIME DP - Unbound Medicine ER -