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INTRODUCCIÓN Y OBJETIVO: El vólvulo gástrico es una entidad que puede manifestarse con un amplio espectro clínico, lo que puede llevar a un retraso en el diagnóstico y tratamiento. El objetivo de nuestro trabajo es definir los tipos de vólvulo gástrico, analizando los factores predisponentes, la clínica, los hallazgos radiológicos y el tratamiento de cada uno de ellos. MATERIAL Y MÉTODOS: Se realizó un estudio descriptivo retrospectivo de los vólvulos gástricos diagnosticados en un hospital terciario durante un periodo de 10 años (2006-2016). Se incluyeron 32 pacientes, que se clasificaron en tres grupos en función de la presentación clínica: 7 con la forma aguda, 12 con la forma crónica y 13 con la forma neonatal-lactante. Se recogieron datos epidemiológicos, clínicos, diagnósticos y de manejo de cada caso. RESULTADOS: El vólvulo gástrico órgano-axial fue el subtipo más frecuente al analizar la totalidad de los pacientes (81%), aunque en la presentación aguda el más prevalente fue el mesentérico-axial (86%). En la forma aguda, la clínica más frecuente fue los vómitos no biliosos (86%), siendo en la forma crónica la sintomatología más variada. El diagnóstico se realizó con tránsito gastroduodenal en la mayoría de los casos. Las opciones de tratamiento fueron cirugía o medidas conservadoras, en función del tipo de vólvulo gástrico. CONCLUSIONES: Existen distintas formas de presentación del vólvulo gástrico (aguda, crónica, neonatal-lactante), cada una con una sintomatología y manejo diferentes. Dada la clínica inespecífica, es importante conocer los factores predisponentes y los hallazgos que aumentan su sospecha en la radiografía. La prueba de elección para su diagnóstico es el tránsito gastroduodenal

INTRODUCTION AND OBJECTIVE: Gastric volvulus is an entity with a broad clinical spectrum, which can lead to a delay in diagnosis and treatment. The purpose of this study is to define the types of gastric volvulus, analyzing the predisposing factors, clinical, radiological findings and treatment of each one. MATERIALS AND METHODS: A retrospective, descriptive study of the gastric volvulus diagnosed at a tertiary hospital was carried out during a period of 10 years (2006-2016). Thirty-two patients were included, which were classified into three groups according to the clinical presentation: 7 with the acute form, 12 with the chronic form and 13 with the neonatal form. Epidemiological, clinical, diagnostic and management data were collected for each case. RESULTS: Organo-axial gastric volvulus was the most frequent subtype of all the sample (81%), although in the acute presentation, the most prevalent subtype was the mesentero-axial (86%). In the acute form, the most common symptom was non-bilious vomiting (86%), whereas in the chronic form the clinical presentation was more varied. The diagnosis was made with upper gastrointestinal series in most cases. Surgical or conservative treatment were chosen depending on the type of gastric volvulus. CONCLUSIONS: There are different forms of presentation of gastric volvulus (acute, chronic, neonatal), with different clinical features and implications with respect to treatment options. Due to its nonspecific clinical presentation, it is important to know the predisposing factors and the common radiological findings highly suggestive of the diagnosis. An upper gastrointestinal series is the study of choice for its diagnosis

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BACKGROUND: Gastric volvulus in children is uncommon, and characteristic radiographic findings might not be recognized. OBJECTIVE: To present the spectrum of clinical and imaging findings, correlate the type of gastric volvulus with clinical outcome, and identify imaging findings to aid in early diagnosis. MATERIALS AND METHODS: Medical records and imaging findings of ten children with gastric volvulus were reviewed. Imaging included abdominal radiographs, upper gastrointestinal (UGI) series, and CT. The diagnosis (organoaxial, mesenteroaxial or mixed type) was made on the UGI series (n = 9) and CT (n = 1), and confirmed surgically in seven children. RESULTS: Patients were classified based on presentation: four acute, four chronic, and two neonatal. All of the acute group (three mesenteroaxial and one mixed type) had abnormal radiographic findings: three spherical gastric distension, four paucity of distal gas, three elevated left hemidiaphragm, one overlapping pylorus and gastric fundus, one unusual nasogastric tube course, and one situs inversus. All underwent emergent surgery. Three had diaphragmatic abnormalities. One had heterotaxy. Patients in the chronic group (three organoaxial, one mesenteroaxial) had long-standing symptoms. Most had associated neurologic abnormalities. In the neonatal group, organoaxial volvulus was found incidentally on the UGI series. CONCLUSION: A spectrum of findings in gastric volvulus exists. Mesenteroaxial volvulus has greater morbidity and mortality. Radiographic findings of spherical gastric dilatation, paucity of distal gas and diaphragmatic elevation are suggestive of acute volvulus, particularly in patients with predisposing factors.

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Paciente de 23 días de vida con vómitos biliosos de 24 horas de evolución, sin antesedentes perinatológicos de importancia

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Paciente de 23 días de vida con vómitos biliosos de 24 horas de evolución, sin antesedentes perinatológicos de importancia

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El vólvulo gástrico crónico es una entidad de baja frecuencia y generalmente no diagnosticada en forma temprana dada la sintomatología poco específica que presenta. Se realizó un análisis de 5 casos, 2 organoaxiales y 3 mesenteroaxiales. Los dos primeros se asociaron a factores predisponentes que requirieron cirugía; los restantes tuvieron buena evolución con tratamiento médico. Se analizan las diferentes modalidades de presentación y sus posibilidades de tratamiento

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El vólvulo gástrico crónico es una entidad de baja frecuencia y generalmente no diagnosticada en forma temprana dada la sintomatología poco específica que presenta. Se realizó un análisis de 5 casos, 2 organoaxiales y 3 mesenteroaxiales. Los dos primeros se asociaron a factores predisponentes que requirieron cirugía; los restantes tuvieron buena evolución con tratamiento médico. Se analizan las diferentes modalidades de presentación y sus posibilidades de tratamiento (AU)

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El vólvulo gástrico es la rotación del estómago o un segmento del mismo, alrededor de alguno de sus ejes anatómicos, es una entidad clínica de observación infrecuente, en Latinoamérica hay descritos hasta el momento 51 casos. La etiopatogenia está relacionada con la relajación de los ligamentos de sostén. La clínica depende de la forma de presentación aguda o crónica, el diagnóstico se basa, además del cuadro clínico, en el estudio radiográfico del tórax y el transito baritado esofagogástrico. El tratamiento es fundamentalmente quirurgico. Se requiere pensar en esta patología, llegar a un diagnóstico y correccion tempranos para disminuir la mortalidad, que en ocaciones llega al 25 porciento

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Gastric volvulus is an uncommon foregut condition. Literature survey based on Medline search between 1993 and end of 1996 indicated there were thus far approximately 750 cases of gastric volvulus with 100 involving children. Gastric volvulus frequently presents in chronic or recurrent form and symptoms are usually non-specific causing delay in diagnosis. The acute type is however potentially lethal if not properly managed. Four cases, an acute volvulus in a child and three chronic lesions in adults are presented with a discussion of the pathology, aetiology, manifestations and treatment of the condition.

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El volvulo gastrico es una entidad clinica de observacion extremadamente rara por cuanto se encuentran en la literatura mundial no más de 500 casos; de ahi que habitualmente no se piense en esta patologia y la demora diagnostica puede ser de consecuencias fatales. Se presentan 2 casos diagnosticados e intervenidos en el Hospital Universitario de Cartagena; ambos, adultos jovenes: mujer de 23 y hombre de 30 años, los cuales consultaron por dolor epigástrico, vomitos y distension abdominal, en uno de ellos. La radiografia del torax en la mujer evidencio neumoperitoneo masivo; la del abdomen simple mostro marcada dilatacion gástrica con imagen sugestiva de volvulo gastrico. En el hombre, la radiografia del torax sugirio alteracion diafragmatica que, sumada al antecedente de trauma torácico 1 año atrás, llevo a la práctica de una serie gastroduodenal con bario, que mostro una imagen compatible con dicho diagnostico. En ambos pacientes se uso la via de acceso por la linea media, comprobándose el volvulo organoaxial, asociado en la mujer a relajacion de los ligamentos de sosten del estomago y a una hernia diafragmatica izquierda en el hombre, de la cual formaban parte el fondo y un segmento del cuerpo gastrico que se hallaban intratorácicos; en los 2 casos se produjo perforacion gástrica sobre la curvatura menor. La tecnica quirurgica, además de la destorsion del volvulo, incluyo rafia de la perforacion gástrica, gastropexia y correccion del defecto diafragmático en el caso que se comprobo. Los pacientes fueron dados de alta a los 10 dias bajo controles posteriores, sin alteraciones. Se realizó una revision de los aspectos clinicos, diagnosticos y terapeuticos más notables.

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Partial obstruction was the cause of delayed gastric emptying in 12 patients after a Roux-en-Y gastrojejunostomy in a consecutive personal series of 42 patients between 1975 and 1989. Four types of obstruction were identified. Type I was due to a kinked loop of jejunum where it passed through the mesocolon. Type II had the anastomosis too high on the gastric pouch, type III was due to an obstructing marginal ulcer, and type IV had a pouchlike deformity develop in the upper jejunum at the anastomosis that gradually compressed the outflow tract. No patient had stenosis of the anastomosis. The upper gastrointestinal (GI) series plus nuclear studies of the liquid and solid phase gastric emptying provided evidence of the presence and degree of delayed gastric emptying but not the site or cause of the obstruction. Upper GI endoscopy provided precise evidence of the site of the partial obstruction, its anatomic nature, and the presence of a bezoar or marginal ulcer. Of the 42 patients, 4 had surgical correction, and in 6 patients the obstruction was relieved by endoscopic manipulation; all patients have been relieved of their symptoms. Partial obstruction was the only cause of delayed gastric emptying in this series, and contrary to recent reports, no patient required a total or near total gastrectomy.

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A male patient was hospitalised for recurrent epigastric pain, abdominal fullness and vomiting. Peptic ulcer was suspected. Barium studies revealed the presence of chronic organo-axial volvulus of stomach. Anterior gastropexy associated with subdiaphragmatic displacement of transverse colon was done with satisfactory results.

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After discussing the classification of the various types of gastric volvulus, the aetiopathogenetic factors that occur in this rare stomach pathology are reviewed. The personal series is reported and the clinical, radiological and above all therapeutic aspects connected with the pathology discussed. It is concluded that, in these cases too, the aims to pursue are the formulation of early diagnosis and implementation of quick, correct treatment for the purpose of eliminating the basic pathology and preventing necrosis of the gastric wall setting in.

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A case is presented of acute gastric volvulus associated with paraesophageal hernia. Gastric volvulus is an infrequent clinical entity that generally appears in chronic form secondary to diaphragmatic pathology. Pathogenesis rests on two factors, relaxation of the supporting ligaments and neighboring associated pathology that acts to trigger gastric distension. Early diagnosis and treatment of acute forms and prophylactic surgery of chronic forms would lead to practically null mortality figures. The surgical technique, aside from devolvulation, includes hiatal repair in cases associated with paraesophageal hernia, gastropexy being sufficient for other forms.

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Although para-oesophageal hiatal hernia is the commonest cause of gastric volvulus, other causes of gastric volvulus require emphasis and 16 cases of gastric volvulus unassociated with hiatal hernia are reported. Delayed presentation following diaphragmatic injury was common. It is recommended that a thoracolaparotomy be performed in these patients to facilitate reduction of the volvulus, and division of intrathoracic adhesions under direct vision. In the secondary type of gastric volvulus accurate diagnosis is mandatory. Failure to recognize and treat associated disease will result in recurrence of the volvulus. A rational approach to the management of gastric volvulus is proposed.

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Cases of acute or chronic abdominal complaints in adults can be accounted for as conditions resulting from volvulus of the stomach with oesophagial hernia. In a total of 73 cases of hiatus hernias the author has observed 6 patients with a simultaneous volvulus of the stomach (8,1%) from 1967 to 1976. Pathogenesis, symptoms, surgical indication and the operative technique are discussed. By means of gastropexy, fundiplication and narrowing of the oesphageal hiatus the patients could be freed of complaints and recurrences.

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