Gastric volvulus: Difference between revisions
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*Evaluate for other causes of pain | *Evaluate for other causes of pain | ||
*[[CXR]] may show retrocardiac air-filled gastric shadow<ref>https://epmonthly.com/article/gastric-volvulus/</ref> | *[[CXR]] may show retrocardiac air-filled gastric shadow<ref>https://epmonthly.com/article/gastric-volvulus/</ref> | ||
*Upright CXR and abdominal | *Upright CXR and [[abdominal x-ray]] | ||
**Intrathoracic, upside-down stomach | **Intrathoracic, upside-down stomach | ||
**Double air fluid level in stomach | **Double air fluid level in stomach | ||
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*[[NG tube]] for decompression | *[[NG tube]] for decompression | ||
*Surgery consult | *Surgery consult | ||
*Analgesia | *[[Analgesia]] | ||
==Disposition== | ==Disposition== | ||
Latest revision as of 16:33, 28 October 2019
Background
- Abnormal rotation of the stomach around its short or long axis
- Rare but potentially life-threatening due to potential for untreated volvulus to progress to strangulation and cause gastric ischemia and perforation
- Usually associated with paraesophageal hernia or diaphragmatic eventration[1]
Clinical Features
- Usually appear relatively well until progressed to gastric ischemia
- Abdominal pain/tenderness and distension, particularly upper abdomen
- Vomiting, retching that often does not respond to antiemetics
Differential Diagnosis
Diffuse Abdominal pain
- Abdominal aortic aneurysm
- Acute gastroenteritis
- Aortoenteric fisulta
- Appendicitis (early)
- Bowel obstruction
- Bowel perforation
- Diabetic ketoacidosis
- Gastroparesis
- Hernia
- Hypercalcemia
- Inflammatory bowel disease
- Mesenteric ischemia
- Pancreatitis
- Peritonitis
- Sickle cell crisis
- Spontaneous bacterial peritonitis
- Volvulus
Epigastric Pain
- Gastroesophageal reflux disease (GERD)
- Peptic ulcer disease with or without perforation
- Gastritis
- Pancreatitis
- Gallbladder disease
- Myocardial Ischemia
- Splenic Infarctionenlargement/rupture/aneurysm
- Pericarditis/Myocarditis
- Aortic dissection
- Hepatitis
- Pyelonephritis
- Pneumonia
- Pyogenic liver abscess
- Fitz-Hugh-Curtis Syndrome
- Hepatomegaly due to CHF
- Bowel obstruction
- SMA syndrome
- Pulmonary embolism
- Bezoar
- Ingested foreign body
Evaluation
- Evaluate for other causes of pain
- CXR may show retrocardiac air-filled gastric shadow[2]
- Upright CXR and abdominal x-ray
- Intrathoracic, upside-down stomach
- Double air fluid level in stomach
- Collapsed small bowel
- CT abdomen most helpful
- Gastric herniation around points of torsion
- May show signs of gastric ischemia, seen a lack of contrast enhancement of gastric wall
Management
Disposition
- Admit
See Also
External Links
References
- ↑ Wu MH, Chang YC, Wu CH, Kang SC, Kuan JT. Acute gastric volvulus: a rare but real surgical emergency. Am J Emerg Med. 2010;28(1):118.e5-7.
- ↑ https://epmonthly.com/article/gastric-volvulus/