Gastric volvulus

Commonest presentation:

Severe epigastric pain

Retching without vomiting

Singleton’s classification:

Organoaxial : stomach rotates around anaxis connecting the GOJ and the pylorus, with the antrum rotating in the opposite direction to the fundus. Commonest type, occurring in 59% of cases

Usually associated with diaphragmatic defects

Strangulation and necrosis commonly occur and reported in 5-28% of cases

Mesenteroaxial type

Stomach folds along a line between the lesser and greater curve (line of mesenteric vessels)

The antrum rotates anteriorly and superiorly. The rotation is usually incomplete and occurs intermittently.

Strangulation is uncommon

Occurs in approximately 29% of cases

These patients usually have chronic symptoms and occur without diaphragmatic defects.

Combined type: rare form where stomach twists in both directions. Usually seen in patients with chronic volvulus.