Sumita Jain, Professor. SMS Hospital
Gastric Volvulus was first described in 1896 by Berti. It is a rotation of stomach around a fixed axis which is greater than 180 degrees. The incidence if this in males and females are equal. It is mainly observed in infants and young adults and rarely seen in the elderly (>50 yrs). A dreaded complication of gastric volvulus is gastric strangulation (observed in 28% cases). It's classification is proposed by Singleton as (i) Organo-axial type (59%), (ii) Mesentero-axial type (29 %) and (iii) Mixed (12%).
We have experience of treating three cases of 'mesentrico axial gastric volvulus'. All patients presented in acute stage having upper abdominal pain, distention and recurrent vomiting. All patients underwent upper GI endoscopy and barium meal to confirm the diagnosis. These were managed through laproscopic surgery. All our patients had uneventful surgeries and are doing well in follow-up.
Conclusion: From our experience with this rare presentation of mesentrico axial gastric volvulus, we conclude that this disease can be managed by minimal invasive surgery with no morbidity and mortality. The component of surgery should include reduction of volvulus, excision of hernial sac, repair of diaphragmatic defect and anti reflux procedure (if required), and gastrostomy tube placement. The excision of hernial sac and gastrostomy tube placement prevents recurrence and further complications. Hence, our procedure is superior to other procedures like endoscopic reduction and gastrostomy or alpha-loop or J-type technique. There are many other variations of gastropexy available like tanner's slide, oozler's operation, gastrojejunostomy with gastro-colic discontinuation, but our experience has shown that a simple pexy by doing 2 point fixation – suturing the fundus to the diaphragm and gastorstomy in the distal stomach helps to prevent recurrence.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 91826
Program Number: P034
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster