Volvulus of the stomach

Volvulus of the stomach

Rotation of the stomach usually occurs around the axis and between its two fixed points, i.e. the cardia and the pylorus. In theory , rotation can occur in the horizontal (organoaxial) or vertical (mesenteroaxial) direction, but the former is more common. V olvulus is usually associated with a large diaphrag - matic defect around the oesophagus (paraoesophageal herni - ation) ( Figure 67.35 ). Commonly the transverse colon moves upwards to lie under the left diaphragm, taking the stomach with - it. The stomach and colon may both enter the chest through the eventration of the diaphragm. The condition is commonly chronic, the patient presenting with di ffi culty in ea ting. An acute presentation with ischaemia may occur. Endoscopically , it can be extremely di ffi cult to identify the anatomy , and this is one situation in which the contrast radiograph is superior. If symptomatic, surgical treatment is required increasingly by a laparoscopic approach. If there is a hernia, the sac and its contents (usually the stomach) should be reduced. The defect in the diaphragm should be closed, if necessary , with a mesh. It is advisable to separate the stomach from the transverse colon and to perform an anterior gastropexy to fix the stomach to the anterior abdominal wall.

Figure 67.35 Barium meal showing organoaxial volvulus of the stom ach associated with eventration of the diaphragm.