eMedicine Specialties > General Surgery > Abdomen

Gastric Volvulus: Workup

Author: William W Hope, MD, Assistant Professor of Surgery, University of North Carolina at Chapel Hill School of Medicine; Director of Surgical Education, Department of Surgery, New Hanover Regional Medical Center/South Eastern Area Health Education Center
Coauthor(s): Mohamed Akoad, MD, Liver Transplant Surgeon, Division of Hepatobiliary and Liver Transplantation, Department of Surgery, Veterans Administration Pittsburgh Healthcare System; Richard W Golub, MD, FACS, Consulting Surgeon, Sarasota Memorial Hospital and Doctors Hospital; Consulting Surgeon, Intercoastal Medical Group
Contributor Information and Disclosures

Updated: Jul 21, 2009

Workup

Laboratory Studies

Biochemical tests are usually not diagnostic; however, hyperamylasemia and elevated serum alkaline phosphatase have been reported.18 There has also been a report of hyperamylasemia in gastric volvulus leading to a missed diagnosis of pancreatitis.19

Imaging Studies

  • Demonstrated through chest radiography, a retrocardiac, gas-filled viscus in cases of intrathoracic stomach confirms the diagnosis.
  • Plain abdominal radiography reveals a massively distended viscus in the upper abdomen. In organoaxial volvulus, plain films may show a horizontally oriented stomach with a single air fluid level20 and a paucity of distal gas.21 In mesenteroaxial volvulus, plain abdominal radiographic findings include a spherical stomach on supine images and 2 air-fluid levels on erect images, with the antrum positioned superior to the fundus.7
  • The diagnosis of gastric volvulus is usually based on barium studies22,23 ; however, some authors recommend computed tomography (CT) scanning as the imaging modality of choice.24,25 Upper GI contrast studies (using barium or gastrograffin) are sensitive and specific if performed with the stomach in the "twisted" state25 and may show an upside-down stomach. Contrast studies have been reported to have a diagnostic yield in 81-84% of patients.23,26,27,28
  • Often performed for an evaluation of acute abdominal pain, a CT scan can offer immediate diagnosis by showing 2 bubbles with a transition line. Proponents of CT scanning in the diagnosis of gastric volvulus report several benefits, including the ability to rapidly diagnose the condition based on a few coronal reconstructed images, the ability to detect the presence or abscess of gastric pneumatosis and free air, the detection of predisposing factors (ie diaphragmatic or hiatal hernias), and the exclusion of other abdominal pathology.25,29
  • Upper GI endoscopy showing distortion of the gastric anatomy with difficulty intubating the stomach or pylorus can be highly suggestive of gastric volvulus.25 Late stage of gastric volvulus with strangulation of the blood supply can result in progressive ischemic ulceration or mucosal fissuring.30

More on Gastric Volvulus

Overview: Gastric Volvulus
Workup: Gastric Volvulus
Treatment: Gastric Volvulus
Follow-up: Gastric Volvulus
References
Further Reading
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References

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Keywords

gastric volvulus, volvulus, abnormal rotation of the stomach, closed loop obstruction, incarceration, strangulation, diaphragmatic defects, paraesophageal hernias, upside-down stomach, severe epigastric pain, nonproductive retching, endoscopic reduction, percutaneous endoscopic gastrostomy, gastrectomy, anterior gastropexy

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Contributor Information and Disclosures

Author

William W Hope, MD, Assistant Professor of Surgery, University of North Carolina at Chapel Hill School of Medicine; Director of Surgical Education, Department of Surgery, New Hanover Regional Medical Center/South Eastern Area Health Education Center
William W Hope, MD is a member of the following medical societies: American College of Surgeons, North Carolina Medical Society, and Society of American Gastrointestinal and Endoscopic Surgeons
Disclosure: Nothing to disclose.

Coauthor(s)

Mohamed Akoad, MD, Liver Transplant Surgeon, Division of Hepatobiliary and Liver Transplantation, Department of Surgery, Veterans Administration Pittsburgh Healthcare System
Disclosure: Nothing to disclose.

Richard W Golub, MD, FACS, Consulting Surgeon, Sarasota Memorial Hospital and Doctors Hospital; Consulting Surgeon, Intercoastal Medical Group
Richard W Golub, MD, FACS is a member of the following medical societies: American College of Gastroenterology, American College of Surgeons, American Society for Gastrointestinal Endoscopy, American Society of Colon and Rectal Surgeons, Association for Academic Surgery, Association for Surgical Education, Crohns and Colitis Foundation of America, Society for Surgery of the Alimentary Tract, and Society of American Gastrointestinal and Endoscopic Surgeons
Disclosure: Nothing to disclose.

Medical Editor

Juan B Ochoa, MD, Assistant Professor, Department of Surgery, University of Pittsburgh
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

David L Morris, MD, PhD, Professor, Department of Surgery, St George Hospital, University of New South Wales, Australia
Disclosure: RFA Medical None Director; MRC Biotec None Director

CME Editor

Paolo Zamboni, MD, Professor of Surgery, Chief of Day Surgery Unit, Chair of Vascular Diseases Center, University of Ferrara, Italy
Paolo Zamboni, MD is a member of the following medical societies: American Venous Forum and New York Academy of Sciences
Disclosure: Nothing to disclose.

Chief Editor

John Geibel, MD, DSc, MA, Vice Chairman, Professor, Department of Surgery, Section of Gastrointestinal Medicine and Department of Cellular and Molecular Physiology, Yale University School of Medicine; Director of Surgical Research, Department of Surgery, Yale-New Haven Hospital
John Geibel, MD, DSc, MA is a member of the following medical societies: American Gastroenterological Association, American Physiological Society, American Society of Nephrology, Association for Academic Surgery, International Society of Nephrology, New York Academy of Sciences, and Society for Surgery of the Alimentary Tract
Disclosure: AMGEN Royalty Other

 
 
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