Volvulus of the Stomach

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Gastric obstruction due to volvulus of the stomach is an uncommon condition first described in 1866 by Berti1 as an autopsy finding. In 1897 the condition was recognized by Berg2 at operation. Subsequent individual case reports have been summarized, and a diagnostic clinical picture has evolved.3,4

The cases are classified on the basis of pathology as (1) idiopathic, without associated organic lesion, and (2) complex, with associated organic lesion. The term total volvulus is applied to those cases in which there exists a minimum of 180 degrees rotation with complete obstruction. Partial volvulus designates those cases with less than 180 degrees rotation and, as a rule, incomplete obstruction.

Kocher5 first distinguished the two types of rotation anatomically. The least common of these is the volvulus mesenterio-axial type, in which the axis of rotation is at right angles to the cardiopyloric line. The pylorus rotates anteriorly and to the left of the midline, causing acute kinking of the anterior wall of the stomach on itself and thus obstruction (fig. 1).

More common is the volvulus organo-axial type, in which the axis of rotation passes through the cardiac and the pyloric orifices. The greater curvature may rotate anteriorly or posteriorly, coming to lie superior to the lesser curvature, and, depending on the degree of rotation, resulting in total or partial volvulus (fig. 2). As a result of this rotation the transverse colon may be carried superiorly and become obstructed.4 It is interesting to note that the blood vessels have rarely been found. . .



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