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Digestive Disease Interventions 2022; 06(04): 323-330
DOI: 10.1055/s-0042-1750048
Review Article

Management and Outcomes in Gastric Volvulus: A Tiered Approach

Alan Askari 
1   Department of Upper Gastrointestinal Surgery, Luton and Dunstable University Hospital, Luton, United Kingdom
,
Egemen Tezcan
1   Department of Upper Gastrointestinal Surgery, Luton and Dunstable University Hospital, Luton, United Kingdom
,
Krashna Patel
1   Department of Upper Gastrointestinal Surgery, Luton and Dunstable University Hospital, Luton, United Kingdom
,
Md Tanveer Adil
1   Department of Upper Gastrointestinal Surgery, Luton and Dunstable University Hospital, Luton, United Kingdom
,
Aruna Munasinghe
1   Department of Upper Gastrointestinal Surgery, Luton and Dunstable University Hospital, Luton, United Kingdom
,
Omer Al-Taan
1   Department of Upper Gastrointestinal Surgery, Luton and Dunstable University Hospital, Luton, United Kingdom
,
Vigyan Jain
1   Department of Upper Gastrointestinal Surgery, Luton and Dunstable University Hospital, Luton, United Kingdom
,
Periyathambi Jambulingam
1   Department of Upper Gastrointestinal Surgery, Luton and Dunstable University Hospital, Luton, United Kingdom
,
Farhan Rashid
1   Department of Upper Gastrointestinal Surgery, Luton and Dunstable University Hospital, Luton, United Kingdom
› Author Affiliations Funding No funding was sought for this study.
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Abstract

Introduction Gastric volvulus is a rare yet life-threatening condition requiring urgent attention. In this case series and literature review, we present the difficulties in management and outcome in patients with gastric volvulus and suggest a tiered framework to guide management. All consecutive cases at a single institution presenting between January 1, 2010, and June 30, 2020, were included. Chi-squared analyses were undertaken to compare outcomes across different groups. A total of 48 patients presented with gastric volvulus; the median age was 78 years (interquartile range [IQR]: 69–84) and 70.8% were female. Most patients had an ASA score of III (n = 19/48, 39.6%) or IV (n = 14/48, 29.2%). In total, 62.5% (n = 30/48) underwent laparoscopic surgery and mesh was used in 40.0%. Eighteen patients (37.5%) were not suitable candidates for surgery or declined surgery. The median length of stay in those undergoing surgery was 4 days (IQR: 2–6). The complication rate in this cohort was 26.7% (n = 8/30). Of these eight patients, four had postoperative nausea, and four others suffered from pneumothorax, wound hematoma, intra-abdominal bleeding, or intra-abdominal collection. The patient who had a serious intra-abdominal bleed returned to operating room and required blood transfusions on day 1 postsurgery. The readmission rate in the surgery group was 6.6% (n = 2/30), both of who had prolonged nausea and were treated symptomatically. The overall 30-day morality in the surgical group was 3.3%. Over a follow-up period of 37 months, 10.0% had a recurrence of hernia, all of who were managed conservatively. Gastric volvulus is a surgical emergency that is associated with a high rate of morbidity and mortality. A tiered treatment algorithm based on urgency can help deliver timely treatment and standardize care. One in 10 patients post–gastric volvulus repair will have recurrence of para-oesophageal hernia but can be treated conservatively.

Keywords

gastric volvulus - laparoscopy - laparoscopic surgery

Authors' Contribution

The authors confirm that they all contributed significantly to this study to justify their authorship.




Publication History

Received: 28 September 2020

Accepted: 26 April 2022

Article published online:
24 August 2022

© 2022. Thieme. All rights reserved.

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