B P Mesenteroaxial gastric volvulus and wandering spleen

B P Mesenteroaxial gastric volvulus and wandering spleen A A S

Gastric volvulus • twisting of all or part of the stomach more than 180 degrees (closed loop obstruction) obstruction of the flow of material, variable loss of blood supply possible tissue death v classic triad (70% of cases) ① severe epigastric pain ② retching without vomiting ③ inability to pass a nasogastric tube • • Can occur in any age, more common in children M=F

Gastric volvulus • Three classification 1. Organoaxial type (m/c/ type, 59%) • • • stomach rotates around an axis, GE junction – pylorus (long axis) Antrum rotates – anterosuperiorly Fundus rotates – posterinferiorly GC – superiorly, LC – inferiorly usually associated with diaphragmatic defects Strangulation and necrosis commonly occur (5 -28%)

Gastric volvulus • Three classification 2. Mesentericoaxial type (29%) • • • bisects the lesser and greater curvatures (short axis) Antrum rotates anteriorly and superiorly, right to left Posterior surface of the stomach lies anteriorly Rotation usually incomplete and occurs intermittently Vascular compromise is uncommon.

Gastric volvulus • Three classification 2. Mesentericoaxial type (29%)

Gastric volvulus • Three classification 3. Combined type • Rare form, twists mesentericoaxially and organoaxially • makes up the remainder of cases, usually chronic volvulus

Gastric volvulus • Treatment derotation, internal fixation, repair diaphragmatic defect ü Nonoperative mortality rate = as high as 80% ü Mortality rate from acute gastric volvulus = 15 -20% ü Mortality rate from chronic gastric volvulus <13%

Wandering spleen • Spleen migrates from its usual anatomical position • Incidence : <0. 5% • Can cause intermittent torsion • Abnormality of its suspensory ligaments Gastric volvulus and wandering spleen share a common cause – absence of the spleen in the left upper quadrant – ovoid or comma-shaped abdominal mass w splenic vessels – enlarged spleen, with minimal or no enhancement (infarction)

References – – – World J Gastroenterol 2008 : 7; 3948 -3955 Radio. Graphics 2011; 31: 1379– 1402 AJR 2009; 192: 431– 437 World J Gastroenterol 2006; 12: 3938 -3943 Am J Surg Pathol 2007; 31: 1586 -1597 Radiology 2007; 242: 791– 801