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ABDOMINAL IMAGING Table of Contents   
Year : 2003  |  Volume : 13  |  Issue : 4  |  Page : 401-402
Case report : Fibrothorax predisposing to gastric volvulus


Sri Venkateswara Institute Of Medical Sciences, Tirupathi-Ap-517 507, India

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Keywords: Fibrothorax gastric volvulus , organo- axial, mesentero-axial

How to cite this article:
Rao R P, Venkataramanappa M, Ibrarullah M D, Reddy G K, Lakshmi Y, Naik K. Case report : Fibrothorax predisposing to gastric volvulus. Indian J Radiol Imaging 2003;13:401-2

How to cite this URL:
Rao R P, Venkataramanappa M, Ibrarullah M D, Reddy G K, Lakshmi Y, Naik K. Case report : Fibrothorax predisposing to gastric volvulus. Indian J Radiol Imaging [serial online] 2003 [cited 2019 Nov 12];13:401-2. Available from: http://www.ijri.org/text.asp?2003/13/4/401/28718

   Introduction: Top


Gastric volvulus is a rare clinical emergency characterised by rotation of the stomach on itself. Depending upon the axis of rotation, it can be classified into organo-axial type and mesentero- axial type. The reported predisposing factors for these condition's are gastrooesophageal reflux [1], hiatus hernia [2], eventration [3], paralysis of the diaphragm.[4], congenital diaphragmatic hernia [5] and post operative stomach [6]. Here we are presenting a case of mesentero - axial gastric volvulus secondary to left sided fibrothorax due to pulmonary tuberculosis. The plain radiographic findings of this condition are highlighted.


   Case report Top


A forty- years- old woman patient presented with acute pain abdomen and epigastric swelling for one day. Ultrasound revealed fluid distended stomach and minimal free fluid in the abdomen. Plain radiograph of chest revealed infiltrates in the right lung and fibrothorax on left side. The dome of the diaphragm on left side was elevated with crowding of the ribs and mediastinal shift towards the same side [Figure - 1]. Erect plain radiograph of the abdomen revealed grossly distended stomach with a large air-fluid level [Figure - 2]. Another small air- fluid level was noted under the elevated left dome of the diaphragm.[Figure - 2]. An emergency laparotomy revealed mesentero-axial gastric volvulus with no vascular compromise to the torsed segment of the stomach.


   Discussion Top


Gastric volvulus is a rare surgical emergency. It's clinical presentation is characterised by epigastric pain, vigorous unproductive attempts to vomit and inability to pass a naso-gastric tube into the stomach. Gastric volvulus is said to produce symptoms only when the rotation occurs to more than 180 degrees. Lax and long ligaments anchoring the stomach namely gastrohepatic,gastroleinal, gastrocolic and gastrophrenic ligaments are responsible for gastric volvulus [6],[7]. Predisposing conditions like gastrooesphageal reflux, hiatus hernia, eventration, paralysis of the diaphragm and fibrothorax with elevated dome of the diaphragm may lead to gastric volvulus. Gastric volvulus usually occurs in conjunction with oesophageal or para oesophageal hiatus hernia that permits part or all of the stomach to assume an intrathoracic position [4].

Gastric volvulus is classified into two types depending on the axis of rotation. Organo-axial volvulus refers to rotation of the stomach upwards along it's long axis in a line connecting the cardia with the pylorus. In organo-axial volvulus, the antrum moves from an inferior to a superior position. Mesentero-axial volvulus is characterised by stomach rotating around the long axis of the gastrohepatic omentum which corresponds to a line connecting the middle of the lesser curvature with the middle of the greater curvature. Vascular occlusion leads to necrosis, shock and mortality in upto 30% of patients [4]. There fore this condition is a surgical emergency necessitating urgent intervention. The radiographic signs of gastric volvulus are characterestic. These are double air- fluid levels on erect film, inversion of the stomach with the greater curvature above the level of the lesser curvature, postioning of the cardia and pylorus at the same level, high stomach with a cascade appearance of the cardia and hourglass configuration of the body of the stomach with demonstration of a spiral appearance of the rugae [4],[5],8]. In the mesentero - axial type, the antrum is elevated while the fundus is lowered [8]. Differential diagnosis for gastric volvulus are gastric atony, acute gastric dilatation and other causes of gastric obstruction.[8].

 
   References Top

1.Samuel M, Burge DM, Griffiths DM : Gastric volvulus and associated gastro-Oesophageal reflux : Arch Dis Child 1995 Nov;73(5):462-4  Back to cited text no. 1    
2.Teague WJ, Ackroyd R, Watson DI, Devitt PG: Changing patterns in the management of gastric volvulus over 14 years: Br J Surg 2000 Mar ;87(3): 358-61: Comment in BrJ Surg 2000 Sep; 87(9): 1251- 2  Back to cited text no. 2    
3.Chatterjee H, Jagdish S, Rao KS, Srivastava KK: Volvulus of stomach in childhood: Indian J Gastroenterol 1993 Jul ; 12(3): 102-4  Back to cited text no. 3    
4.Gastric Outlet Obstruction In:Ronald L.Eisenberg, Gastrointestinal Radiology A Pattern Approach, Third Edition, Philadelphia, Lippincott-Raven Publishers, Copyright 1996 . 295-296.  Back to cited text no. 4    
5.Leitao B, Mota CR, Enes C, Ferreira P, Vieira P, Requeijo D. Acute gastric volvulus and congenital posterolateral diaphragmatic hernia: Eur J Pediatrtic Surgery 1997 Apr; 7(2):106-8  Back to cited text no. 5    
6.Khemani R, Kantharia C, Shah P, Shah P ; Organo-axial volvulus of the stomach following surgery for the gastric outlet obstruction: Indian J Gastroenterol 1992 Jul; 11(3):144  Back to cited text no. 6    
7.Willsher PC, White RC, Dumbrell P: "Idiopathic" chronic gastric volvulus .: Aust. N Z J Surg 1996 Sep ; 66(9): 647-9  Back to cited text no. 7    
8.Isadore Meschan, David J.Off. Stomach, Duodenum and Pancreas. In: Meschan, Roentgen Signs in Diagnostic Imaging; Vol:1; Second Edition; Philadelphia, W B Saunders Company Copyright 1984. 594-597.  Back to cited text no. 8    

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Correspondence Address:
R P Rao
Sri Venkateswara Institute Of Medical Sciences, Tirupathi - Ap-517 507
India
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Source of Support: None, Conflict of Interest: None


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