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Gastric Volvulus Clinical Presentation

  • Author: William W Hope, MD; Chief Editor: John Geibel, MD, DSc, MSc, MA  more...
Updated: Apr 02, 2015


Gastric volvulus can manifest either as an acute abdominal emergency or as a chronic intermittent problem. The presenting symptoms depend on the degree of twisting and the rapidity of onset.

Acute gastric volvulus

The Borchardt triad (ie, pain, retching, and inability to pass a nasogastric tube) is diagnostic of acute volvulus and reportedly occurs in 70% of cases.[10] Carter et al described three additional findings that are suggestive of gastric volvulus, as follows[8] :

  • Minimal abdominal findings when the stomach is in the thorax
  • Gas-filled viscus in the lower chest or upper abdomen on chest radiograph
  • Obstruction at the site of the volvulus on an upper gastrointestinal (GI) radiographic series

Hiccups have been reported to be a subtle sign in the clinical diagnosis of gastric volvulus.[19]

Intra-abdominal gastric volvulus most commonly manifests as the sudden onset of severe epigastric or left upper quadrant pain. Intrathoracic gastric volvulus manifests as sharp chest pain radiating to the left side of the neck, shoulder, arms, and back. This condition is often associated with cardiopulmonary compromise from gastric distention and may mimic an acute myocardial infarction.

Progressive distention and nonproductive retching follow the pain. Patients may have upper abdominal distention and tenderness if the stomach remains intra-abdominal; however, if the stomach becomes intrathoracic, there may be minimal abdominal findings.

Occasionally, some patients present with hematemesis secondary to mucosal ischemia and sloughing. This can rapidly progress to hypovolemic shock from loss of blood and fluids.

Chronic gastric volvulus

Patients with chronic gastric volvulus typically present with intermittent epigastric pain and abdominal fullness after meals. They may report early satiety, dyspnea, and chest discomfort. Dysphagia may occur if the gastroesophageal junction is distorted. Because of the nonspecific nature of the symptoms, however, patients are often investigated for other common disease entities, such as cholelithiasis and peptic ulcer disease.

An upper GI series can be diagnostic during an acute attack.


Physical Examination

Physical examination findings in patients with gastric volvulus can be nonspecific and relate to the chronicity of the volvulus. Epigastric tenderness and distention can suggest gastric volvulus; in cases of stomach necrosis or severe obstruction, peritonitis can be present.



Strangulation and necrosis are the most feared complications of gastric volvulus; they can be life-threatening and occur most commonly with organoaxial gastric volvulus (5-28% of cases).[8, 9] Gastric perforation occurs secondary to ischemia and necrosis and can result in sepsis and cardiovascular collapse; it can also complicate endoscopic reduction (see Treatment).

Contributor Information and Disclosures

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 East Area Health Education Center

William W Hope, MD is a member of the following medical societies: American College of Surgeons, North Carolina Medical Society, Society of American Gastrointestinal and Endoscopic Surgeons

Disclosure: Serve(d) as a speaker or a member of a speakers bureau for: Cr bars<br/>Received research grant from: Ethicon, cr bard, we gore<br/>Received income in an amount equal to or greater than $250 from: Cr bard, wl gore <br/>Received grant/research funds from Ethicon for research; Received grant/research funds from CR Bard for consulting.


Mohamed Akoad, MD Liver Transplant Surgeon, Division of Hepatobiliary and Liver Transplantation, Department of Surgery, Veterans Administration Pittsburgh Healthcare System

Disclosure: Nothing to disclose.

Chief Editor

John Geibel, MD, DSc, MSc, MA Vice Chair and Professor, Department of Surgery, Section of Gastrointestinal Medicine, and Department of Cellular and Molecular Physiology, Yale University School of Medicine; Director, Surgical Research, Department of Surgery, Yale-New Haven Hospital; American Gastroenterological Association Fellow

John Geibel, MD, DSc, MSc, 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, Society for Surgery of the Alimentary Tract

Disclosure: Received royalty from AMGEN for consulting; Received ownership interest from Ardelyx for consulting.


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.

David L Morris, MD, PhD, FRACS Professor, Department of Surgery, St George Hospital, University of New South Wales, Australia

David L Morris, MD, PhD, FRACS, is a member of the following medical societies: British Society of Gastroenterology

Disclosure: RFA Medical None Director; MRC Biotec None Director

Juan B Ochoa, MD Assistant Professor, Department of Surgery, University of Pittsburgh School of Medicine; Medical and Scientific Director, HCN, Nestle Healthcare Nutrition

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

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Table 1. Anatomic Defects Associated With Gastric Volvulus
Congenital defects Diaphragmatic defects: 43%
Gastric ligaments: 32%
Abnormal attachments, adhesions, or bands: 9%
Asplenism: 5%
Small and large bowel malformations: 4%
Pyloric stenosis: 2%
Colonic distention: 1%
Rectal atresia: 1%
Complicating gastroesophageal surgery
Neuromuscular disorders Poliomyelitis
Source: Miller DL, Pasquale MD, Seneca RP. Gastric volvulus in the pediatric population. Arch Surg. Sep 1991;126(9):1146-9.[10]
Table 2. Causes of Secondary Gastric Volvulus in Adults
Diaphragmatic Defects Gastroesophageal Surgery Neuromuscular Disorder Increased Intra-abdominal Pressure Conditions Leading to Diaphragmatic Elevation
Hiatal hernia


Nissen fundoplication

Total esophagectomy

Highly selective vagotomy

Coronary artery bypass graft

Motor neuron disease


Myotonic dystrophy

Abdominal tumors Phrenic nerve palsy

Left lung resection

Intrapleural adhesions

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