Gastric volvulus is the condition where the stomach twists upon itself. This can be transient, but it can also lead to obstruction, ischemia, and necrosis. Primary gastric volvulus occurs below the diaphragm and is found in a third of cases. Secondary gastric volvulus occurs above the diaphragm and is associated with a defect in the diaphragm or a herniation of the stomach upwards towards the esophagus. One-fifth of cases are found in children (usually diagnosed before the age of 1 year) and are associated with a congenital diaphragmatic anomaly. Peak incidence is in the fifth decade of life.
Pain, violent retching, and inability to pass a nasogastric tube is very suggestive of acute gastric volvulus. Confirmation of the diagnosis is usually made with a plain abdominal radiograph. Treatment requires surgery. Mortality from acute gastric volvulus is around 15-20%, but in cases where blood supply to the stomach has been severely compromised, mortality rates can reach 40-60%.
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