Acute On Chronic Gastric Volvulus: Often a Delayed Diagnosis

Christine Lovato, MD, Giovanni Begossi, MD, Gregory Broderick-Villa, MD, Rupert Horoupian, MD, Ajay Upadhyay, MD. First Surgical Consultants

INTRODUCTION: Acute on chronic gastric volvulus is a life threatening condition potentially associated with a high mortality rate. Because of the vague nature of presenting symptoms, this disease can be easily confused with a medical condition and surgical evaluation is often delayed. We are presenting our clinical series of nine patients diagnosed and treated at our institution.

METHODS: Nine patients presenting with acute on chronic gastric volvulus underwent surgical intervention at our institution from 2006-2013. Pre-operative symptoms including duration and type, if known, as well as comorbidities, operative details and post-operative complications were analyzed.

RESULTS: Mean age was 76 years (64-89 years). Six were male, 3 were female. All surgeries were performed during the same hospitalization and two were considered emergent, performed within 24 hours of admission. The mean duration of symptoms was 89 days (4-180 days), seven had been worked up as a medical etiology on previous admissions and sent home. Seven repairs were completed laparoscopically, one open and one laparoscopic requiring conversion. Mean operative time was 182 minutes (140-308 minutes). There was one death in the immediate post-operative period related to sepsis from gastric ischemia. Post-operative complications included 2 patients with acute renal insufficiency, two patients with anemia requiring blood transfusion, one intra-abdominal abscess, and one decubitus ulcer. One patient developed a late anastomotic stricture requiring dilation.

CONCLUSION: Acute on chronic gastric volvulus is a rare condition that can be misdiagnosed. High level of suspicion and early surgical referral should be always considered. Surgery represents the standard of care with laparoscopy being often an effective approach with reasonable mortality and morbidity.

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