Gastric volvulus is a rare surgical emergency. According to the axis of rotation gastric volvulus can be organoaxial, mesentericoaxial or combined. In case of organoaxial volvulus the stomach rotates around the axis made by joining eosophagogastric junction and the pylorus. The greater curvature either lies anteriorly or superiorly, as found in our case [1
The gastric volvulus can be primary which is the result of either absence or laxity of various ligaments attaching the stomach to the surrounding structures. The secondary gastric volvulus can occur due to various anatomic defects like diaphragmatic hernia, malrotation of gut, asplenia, wandering spleen, pyloric stenosis, traumatic injury to diaphragm, phrenic nerve palsy, abdominal tumors etc [3
]. In our case, acute gastric volvulus was secondary to malrotation of gut. We hypothesize that partial duodenal obstruction might result in gastric over-distension that predispose to an abnormal rotation of stomach around its long axis.
The gastric volvulus may present as acute surgical emergency or with chronic intermittent symptoms. In acute gastric volvulus there is sudden upper abdominal distension associated with pain abdomen. Patient may present with retching as well. In adults the classical Borchardt’s triad may be found which include sudden pain in abdomen, non productive retching and inability to pass NG tube. In case of chronic gastric volvulus the abdominal pain and distension is intermittent as the stomach derotates itself at times. Early satiety and fullness after meal may be the symptoms [1
Both plain and contrast radiographs of abdomen play vital role in diagnosis of gastric volvulus. Plain x-ray abdomen shows typical large air fluid level at the left upper quadrant with paucity of distal gas shadows in organoaxial rotation; similar was found in our case. The barium study is more specific as it can show the position of greater curvature, pylorus and the antrum if done with stomach in twisted state [3
Acute gastric volvulus is a surgical emergency. The delay in the diagnosis and management may result in serious complications like gastric necrosis, gastric perforation, sepsis and cardiovascular failure [6
]. In our case the gastric ischemia had occurred however the stomach was viable after derotation.
The surgical management of gastric volvulus is based upon three principles namely decompression of the distended stomach, correction of volvulus and prevention of recurrence. Both open as well as laparoscopic approaches have been advocated. Stomach should be inspected for any ischemia or necrosis due to the strangulation. If any doubt in viability of stomach arises, then segmental, subtotal or total gastrectomy can be done. Anterior gastropexy, gastrostomy or fundoplication may be added for prevention of gastric volvulus. However correction of various anatomical defects in case of secondary gastric volvulus should always be kept in mind [1
]. Our patient was managed without any additional procedure on stomach as it was secondary to malrotation.