Joint Hospital Grand Round Management of Chronic Gastric Volvulus Kenny K Y Yuen Tseung Kwan O Hospital 20th January, 2007 Kenny K Y Yuen Tseung Kwan O

Joint Hospital Grand RoundJoint Hospital Grand RoundManagement of Management of

Chronic Gastric VolvulusChronic Gastric Volvulus

Joint Hospital Grand RoundJoint Hospital Grand RoundManagement of Management of

Chronic Gastric VolvulusChronic Gastric Volvulus

Kenny K Y YuenKenny K Y YuenTseung Kwan O HospitalTseung Kwan O Hospital

20th January, 200720th January, 2007

Kenny K Y YuenKenny K Y YuenTseung Kwan O HospitalTseung Kwan O Hospital

20th January, 200720th January, 2007

•Clinical scenarioClinical scenario

•HistoryHistory

•Predisposing factorsPredisposing factors

•ClassificationsClassifications

•Clinical presentationsClinical presentations

• InvestigationsInvestigations

•Treatment Treatment

•Clinical scenarioClinical scenario

•HistoryHistory

•Predisposing factorsPredisposing factors

•ClassificationsClassifications

•Clinical presentationsClinical presentations

• InvestigationsInvestigations

•Treatment Treatment

Clinical ScenarioClinical ScenarioClinical ScenarioClinical Scenario

• F/29F/29• Intermittent epigastric painIntermittent epigastric pain for years for years• CrampingCramping after heavy meal, relieved after after heavy meal, relieved after

vomitingvomiting• Weight lossWeight loss 5 kg within 2-3 months 5 kg within 2-3 monthsUpper endoscopyUpper endoscopy • twisted stomachtwisted stomach with difficulty in finding pyloru with difficulty in finding pyloru

ss

• F/29F/29• Intermittent epigastric painIntermittent epigastric pain for years for years• CrampingCramping after heavy meal, relieved after after heavy meal, relieved after

vomitingvomiting• Weight lossWeight loss 5 kg within 2-3 months 5 kg within 2-3 monthsUpper endoscopyUpper endoscopy • twisted stomachtwisted stomach with difficulty in finding pyloru with difficulty in finding pyloru

ss


Erect AXRErect AXR • Double air-fluidDouble air-fluid levels at LUQ levels at LUQ Ba mealBa meal• Stomach Stomach rotated rotated > 180> 180oo

• Body rotates towards the R hemidiaphragmBody rotates towards the R hemidiaphragm• Greater curveGreater curve laying laying same levelsame level as the as the fundus fundus• OrganoaxialOrganoaxial gastric volvulus gastric volvulus• No hiatus hernia No hiatus hernia • No gastric outlet obstructionNo gastric outlet obstruction

Erect AXRErect AXR • Double air-fluidDouble air-fluid levels at LUQ levels at LUQ Ba mealBa meal• Stomach Stomach rotated rotated > 180> 180oo

• Body rotates towards the R hemidiaphragmBody rotates towards the R hemidiaphragm• Greater curveGreater curve laying laying same levelsame level as the as the fundus fundus• OrganoaxialOrganoaxial gastric volvulus gastric volvulus• No hiatus hernia No hiatus hernia • No gastric outlet obstructionNo gastric outlet obstruction

DefinitionDefinitionDefinitionDefinition

• Gastric volvulusGastric volvulus is rotation of all or pa is rotation of all or part of the stomach rt of the stomach more than 180°,more than 180°, whic which may lead to a h may lead to a closed-loop obstructioclosed-loop obstructionn and and possible strangulationpossible strangulation

• Gastric volvulusGastric volvulus is rotation of all or pa is rotation of all or part of the stomach rt of the stomach more than 180°,more than 180°, whic which may lead to a h may lead to a closed-loop obstructioclosed-loop obstructionn and and possible strangulationpossible strangulation

15791579

18661866

18951895

19041904

19201920

19301930

19681968

Ambrose Ambrose ParePare

BertiBerti

BergBerg

BorchardtBorchardt

RoseletRoselet

BuchananBuchanan

TannerTanner

History of Gastric VolvulusHistory of Gastric Volvulus

Described GV during autopsy

Described GV during autopsy

GV after sword woundGV after sword wound

1st successfuloperation

1st successfuloperation Classic

al triad

Classical triad Described

radiologically

Describedradiologically

Clarify anatomicalvariationClarify anatomicalvariation

Etiology & methods of repair

Etiology & methods of repair

AnatomyAnatomy AnatomyAnatomy

Predisposing factorsPredisposing factorsPredisposing factorsPredisposing factors

•Primary Primary – LaxityLaxity of the supporting ligaments of the supporting ligaments– Especially elongation of the Especially elongation of the gastrosplenicgastrosplenic a a

nd/or nd/or gastrocolicgastrocolic ligaments ligaments– one-third of casesone-third of cases

•Primary Primary – LaxityLaxity of the supporting ligaments of the supporting ligaments– Especially elongation of the Especially elongation of the gastrosplenicgastrosplenic a a

nd/or nd/or gastrocolicgastrocolic ligaments ligaments– one-third of casesone-third of cases


•SecondarySecondaryDiaphragmatic defectDiaphragmatic defect – eventration eventration – paraesophageal hiatal herniaparaesophageal hiatal hernia– Bochdalek herniaBochdalek hernia– trauma trauma – paralysisparalysisCongenital bands or adhesionsCongenital bands or adhesionsIntestinal malrotationIntestinal malrotationPyloric stenosis with gastric distensionPyloric stenosis with gastric distensionColon distensionColon distension

•SecondarySecondaryDiaphragmatic defectDiaphragmatic defect – eventration eventration – paraesophageal hiatal herniaparaesophageal hiatal hernia– Bochdalek herniaBochdalek hernia– trauma trauma – paralysisparalysisCongenital bands or adhesionsCongenital bands or adhesionsIntestinal malrotationIntestinal malrotationPyloric stenosis with gastric distensionPyloric stenosis with gastric distensionColon distensionColon distension


• Diaphragmatic defectsDiaphragmatic defects - - 43%43%• Gastric ligamentsGastric ligaments - - 32%32%• Abnormal attachments, adhesions, or bands - 9Abnormal attachments, adhesions, or bands - 9

%%• Asplenism - 5%Asplenism - 5%• Small and large bowel malformations - 4%Small and large bowel malformations - 4%• Pyloric stenosis - 2%Pyloric stenosis - 2%• Colonic distension - 1%Colonic distension - 1%• Rectal atresia - 1%Rectal atresia - 1%

• Diaphragmatic defectsDiaphragmatic defects - - 43%43%• Gastric ligamentsGastric ligaments - - 32%32%• Abnormal attachments, adhesions, or bands - 9Abnormal attachments, adhesions, or bands - 9

%%• Asplenism - 5%Asplenism - 5%• Small and large bowel malformations - 4%Small and large bowel malformations - 4%• Pyloric stenosis - 2%Pyloric stenosis - 2%• Colonic distension - 1%Colonic distension - 1%• Rectal atresia - 1%Rectal atresia - 1%

ClassificationsClassificationsClassificationsClassifications

• OnsetOnset - Acute Vs Chronic - Acute Vs Chronic • LocationLocation – subdiaphragmatic / primary – subdiaphragmatic / primary

Vs supradiaphragmatic / secondaryVs supradiaphragmatic / secondary• Axis of rotationAxis of rotation – organoaxial/ mesente – organoaxial/ mesente

roaxial / combined / unclassified roaxial / combined / unclassified • EtiologyEtiology – type 1(idiopathic) Vs type 2 (c – type 1(idiopathic) Vs type 2 (c

ongenital or acquired)ongenital or acquired)

• OnsetOnset - Acute Vs Chronic - Acute Vs Chronic • LocationLocation – subdiaphragmatic / primary – subdiaphragmatic / primary

Vs supradiaphragmatic / secondaryVs supradiaphragmatic / secondary• Axis of rotationAxis of rotation – organoaxial/ mesente – organoaxial/ mesente

roaxial / combined / unclassified roaxial / combined / unclassified • EtiologyEtiology – type 1(idiopathic) Vs type 2 (c – type 1(idiopathic) Vs type 2 (c

ongenital or acquired)ongenital or acquired)


• SubdiaphragmaticSubdiaphragmatic, or , or primaryprimary– notnot associated associated with diaphragmatic defects with diaphragmatic defects – one third of casesone third of cases

• SupradiaphragmaticSupradiaphragmatic, or , or secondarysecondary– associatedassociated with diaphragmatic defects with diaphragmatic defects – two thirds of casestwo thirds of cases

• SubdiaphragmaticSubdiaphragmatic, or , or primaryprimary– notnot associated associated with diaphragmatic defects with diaphragmatic defects – one third of casesone third of cases

• SupradiaphragmaticSupradiaphragmatic, or , or secondarysecondary– associatedassociated with diaphragmatic defects with diaphragmatic defects – two thirds of casestwo thirds of cases

ClassificationsClassificationsClassificationsClassifications• Organoaxial volvulusOrganoaxial volvulus

Rotates Rotates about the cardiopabout the cardiopyloric axisyloric axis results in an u results in an upside down stomach witpside down stomach with theh the greater curve on tgreater curve on top op

Obstruction may occur at Obstruction may occur at the gastroesophageal juthe gastroesophageal junction and the pyloroannction and the pyloroantral area. tral area.

59%59%Mainly Mainly adultadult

• Organoaxial volvulusOrganoaxial volvulusRotates Rotates about the cardiopabout the cardiop

yloric axisyloric axis results in an u results in an upside down stomach witpside down stomach with theh the greater curve on tgreater curve on top op

Obstruction may occur at Obstruction may occur at the gastroesophageal juthe gastroesophageal junction and the pyloroannction and the pyloroantral area. tral area.

59%59%Mainly Mainly adultadult


• Mesenteroaxial volvMesenteroaxial volvulusulusAnterior rotation about aAnterior rotation about a

n axis n axis perpendicular to perpendicular to the cardiopyloric axisthe cardiopyloric axis

Greater curve remains on Greater curve remains on the bottomthe bottom

29% 29% Mainly Mainly childrenchildren

• Mesenteroaxial volvMesenteroaxial volvulusulusAnterior rotation about aAnterior rotation about a

n axis n axis perpendicular to perpendicular to the cardiopyloric axisthe cardiopyloric axis

Greater curve remains on Greater curve remains on the bottomthe bottom

29% 29% Mainly Mainly childrenchildren

Clinical PresentationClinical PresentationClinical PresentationClinical Presentation

• Borchardt’s classical triad (1904):Borchardt’s classical triad (1904):– epigastric painepigastric pain and and distentiondistention– Non-productive vomitingNon-productive vomiting– difficultydifficulty with nasogastric tube insertion with nasogastric tube insertion

• Borchardt’s classical triad (1904):Borchardt’s classical triad (1904):– epigastric painepigastric pain and and distentiondistention– Non-productive vomitingNon-productive vomiting– difficultydifficulty with nasogastric tube insertion with nasogastric tube insertion

Presenting symptomPresenting symptom AcuteAcute ChronicChronic TotalTotal

Abdominal painAbdominal pain 2424 66 3030

VomitingVomiting 1717 33 2020

UGIB/anaemiaUGIB/anaemia 99 22 1111

Abdominal distensionAbdominal distension 55 00 55

Gastro-esophageal refluxGastro-esophageal reflux 55 22 77

DysphagiaDysphagia 44 33 77

Respiratory symptoms/ chest Respiratory symptoms/ chest painpain

77 00 77

Postprandial discomfortPostprandial discomfort 33 00 33

Altered bowel habitAltered bowel habit 22 00 22

Excess flatulenceExcess flatulence 22 00 22

Acute confusionAcute confusion 11 00 11

DehydrationDehydration 11 00 11Teague et al, BMJ 2000

InvestigationsInvestigationsInvestigationsInvestigations

Barium studyBarium study • high high sensitivitysensitivity and and specificityspecificity• criterion standardcriterion standard for diagnosis for diagnosis• upside-down configurationupside-down configuration of the stomac of the stomac

h h • esophagogastric junctionesophagogastric junction is is lowerlower than n than n

ormal. ormal. • marked marked gastric dilatationgastric dilatation and the and the slowslow papa

ssage of contrastssage of contrast past the site of twisting past the site of twisting

Barium studyBarium study • high high sensitivitysensitivity and and specificityspecificity• criterion standardcriterion standard for diagnosis for diagnosis• upside-down configurationupside-down configuration of the stomac of the stomac

h h • esophagogastric junctionesophagogastric junction is is lowerlower than n than n

ormal. ormal. • marked marked gastric dilatationgastric dilatation and the and the slowslow papa

ssage of contrastssage of contrast past the site of twisting past the site of twisting


X-RayX-Ray• findings findings suggestive suggestive of gastric volvulus should be of gastric volvulus should be

confirmed with a barium studyconfirmed with a barium study• Erect film:Erect film: two air-fluid levelstwo air-fluid levels on the fundus - inf on the fundus - inf

erior, antrum - superiorerior, antrum - superior• Supine film: a beak where the esophagogastric juSupine film: a beak where the esophagogastric ju

nction is seen on normal images nction is seen on normal images

X-RayX-Ray• findings findings suggestive suggestive of gastric volvulus should be of gastric volvulus should be

confirmed with a barium studyconfirmed with a barium study• Erect film:Erect film: two air-fluid levelstwo air-fluid levels on the fundus - inf on the fundus - inf

erior, antrum - superiorerior, antrum - superior• Supine film: a beak where the esophagogastric juSupine film: a beak where the esophagogastric ju

nction is seen on normal images nction is seen on normal images


Endoscopy Endoscopy • Both diagnostic and therapeuticBoth diagnostic and therapeutic• Mainly for Mainly for therapeutictherapeutic

CT / MRI / USGCT / MRI / USG • Not diagnosticNot diagnostic • Consider in patient cannot tolerate endoscopy Consider in patient cannot tolerate endoscopy

or fluoroscopyor fluoroscopy

Endoscopy Endoscopy • Both diagnostic and therapeuticBoth diagnostic and therapeutic• Mainly for Mainly for therapeutictherapeutic

CT / MRI / USGCT / MRI / USG • Not diagnosticNot diagnostic • Consider in patient cannot tolerate endoscopy Consider in patient cannot tolerate endoscopy

or fluoroscopyor fluoroscopy

InvestigationsInvestigationsInvestigationsInvestigationsInvestigationInvestigation OrdereOrdere

ddDiagnostiDiagnosticc

SuggestivSuggestivee

No No yieldyield

Barium mealBarium meal 2525 1414 77 44

CXRCXR 1919 00 55 1414

Upper endoscopyUpper endoscopy 1818 55 66 77

AXRAXR 88 00 33 44

Manometry/pHManometry/pH 44 00 00 44

Chest CT scanChest CT scan 22 00 11 11

ColonoscopyColonoscopy 11 00 00 11

USGUSG 11 00 00 11

Teague et al, BMJ 2000

TreatmentTreatmentTreatmentTreatment

• Aims:Aims:– Reduction Reduction of volvulus of volvulus – Gastric Gastric fixationfixation– RepairRepair of predisposing factors of predisposing factors

• OpenOpen Vs Vs EndoscopicEndoscopic Vs Vs LaparoscopicLaparoscopic Vs Vs Combined endoscopic and laproscopicCombined endoscopic and laproscopic

• Aims:Aims:– Reduction Reduction of volvulus of volvulus – Gastric Gastric fixationfixation– RepairRepair of predisposing factors of predisposing factors

• OpenOpen Vs Vs EndoscopicEndoscopic Vs Vs LaparoscopicLaparoscopic Vs Vs Combined endoscopic and laproscopicCombined endoscopic and laproscopic

Treatment – open surgery Treatment – open surgery Treatment – open surgery Treatment – open surgery

Open SurgeryOpen Surgery (traditional treatment >10 years ago)(traditional treatment >10 years ago)

• Diaphragmatic hernia repairDiaphragmatic hernia repair• Division of bandsDivision of bands• GastropexyGastropexy• Partial gastrectomy (in case of necrosis)Partial gastrectomy (in case of necrosis)• Gastropexy with division of gastrocolic ligamenGastropexy with division of gastrocolic ligamen

t (t (Tanner’s OperationTanner’s Operation))• GastrojejunostomyGastrojejunostomy• Fundoantral gastrogastrostomy (Fundoantral gastrogastrostomy (Opolzer’s OpOpolzer’s Op

erationeration))• Repair of eventration of diaphragmRepair of eventration of diaphragm

Open SurgeryOpen Surgery (traditional treatment >10 years ago)(traditional treatment >10 years ago)

• Diaphragmatic hernia repairDiaphragmatic hernia repair• Division of bandsDivision of bands• GastropexyGastropexy• Partial gastrectomy (in case of necrosis)Partial gastrectomy (in case of necrosis)• Gastropexy with division of gastrocolic ligamenGastropexy with division of gastrocolic ligamen

t (t (Tanner’s OperationTanner’s Operation))• GastrojejunostomyGastrojejunostomy• Fundoantral gastrogastrostomy (Fundoantral gastrogastrostomy (Opolzer’s OpOpolzer’s Op

erationeration))• Repair of eventration of diaphragmRepair of eventration of diaphragm

Treatment- endoscopicTreatment- endoscopicTreatment- endoscopicTreatment- endoscopic

Endoscopic reductionEndoscopic reduction

Alpha-loop maneuver Alpha-loop maneuver Tat-Kin Tsang et al ,1995Tat-Kin Tsang et al ,1995

J-type maneuverJ-type maneuver D.K. Bhasin et al, 1990D.K. Bhasin et al, 1990

• +/- +/- gastrostomygastrostomy for the fixation of stomach to t for the fixation of stomach to the abdominal wallhe abdominal wall

Endoscopic reductionEndoscopic reduction

Alpha-loop maneuver Alpha-loop maneuver Tat-Kin Tsang et al ,1995Tat-Kin Tsang et al ,1995

J-type maneuverJ-type maneuver D.K. Bhasin et al, 1990D.K. Bhasin et al, 1990

• +/- +/- gastrostomygastrostomy for the fixation of stomach to t for the fixation of stomach to the abdominal wallhe abdominal wall

Treatment – alpha loopTreatment – alpha loopTreatment – alpha loopTreatment – alpha loop

A,B,C Survey of the stomach and gastric volvulus and formation of alpha-loop

D,E,F, Completed formation of alpha-loop with the advancement of tip pf the endoscope into the antrum and uncoiling of the loop and reduction of the volvulus

Tsang et al. 1995

Treatment - J-type maneuverTreatment - J-type maneuverTreatment - J-type maneuverTreatment - J-type maneuver

A,B Formation of the ”J “by turn extremely up and to the right to locate the lumen

C,D,E Endoscopy is maneuvered into the duodenal cap. Tip of the endoscopy is turned to right and partially locked. Endoscopy is rotated through 180o in anti-clockwise direction and withdrawn Bhasin et al. 1990

Treatment - laparoscopicTreatment - laparoscopicTreatment - laparoscopicTreatment - laparoscopic

• 3-ports / 4-ports / 5-ports 3-ports / 4-ports / 5-ports • ReductionReduction of Volvulus of Volvulus• AnchoringAnchoring fundus of stomach to the fundus of stomach to the diaphragmdiaphragm • Greater curveGreater curve of the stomach to of the stomach to anterior abdomianterior abdomi

nal wallnal wall• +/- repair of +/- repair of diaphragmatic defectdiaphragmatic defect• +/-+/- fundoplication fundoplication or/and or/and esocardiopexyesocardiopexy – – prevepreve

nt post-operative GERDnt post-operative GERD• +/- +/- gastrostomygastrostomy

• 3-ports / 4-ports / 5-ports 3-ports / 4-ports / 5-ports • ReductionReduction of Volvulus of Volvulus• AnchoringAnchoring fundus of stomach to the fundus of stomach to the diaphragmdiaphragm • Greater curveGreater curve of the stomach to of the stomach to anterior abdomianterior abdomi

nal wallnal wall• +/- repair of +/- repair of diaphragmatic defectdiaphragmatic defect• +/-+/- fundoplication fundoplication or/and or/and esocardiopexyesocardiopexy – – prevepreve

nt post-operative GERDnt post-operative GERD• +/- +/- gastrostomygastrostomy


2 vertical lines – fundus anchored to diaphragmX – anterior gastropexy stitches

A – camera, B – liver retractor, C,D,E - operating ports


EsocardiopexyEsocardiopexy PhrenofundopexyPhrenofundopexy

Anterior gastropexyAnterior gastropexy

Management - combinedManagement - combinedManagement - combinedManagement - combined

•Described by Arben Beqiri (1997):Described by Arben Beqiri (1997):– Use Use endoscopicendoscopic T-fastenersT-fasteners instead of PEG fo instead of PEG fo

r anchoringr anchoring– Laparoscopy - reduction of volvulus Laparoscopy - reduction of volvulus – Endoscopy - placement of T-fastenersEndoscopy - placement of T-fasteners– Less time consumingLess time consuming

•Described by Arben Beqiri (1997):Described by Arben Beqiri (1997):– Use Use endoscopicendoscopic T-fastenersT-fasteners instead of PEG fo instead of PEG fo

r anchoringr anchoring– Laparoscopy - reduction of volvulus Laparoscopy - reduction of volvulus – Endoscopy - placement of T-fastenersEndoscopy - placement of T-fasteners– Less time consumingLess time consuming


Follow-upFollow-up • Clinical Clinical

– reflux symptomsreflux symptoms– recurrent of symptoms - detection of recurrence recurrent of symptoms - detection of recurrence – removal of PEG tuberemoval of PEG tube

• Imaging Imaging – Post OT contrast study– Post OT contrast study (no consensus of interval - Day 2 to 3 months)(no consensus of interval - Day 2 to 3 months)

Follow-upFollow-up • Clinical Clinical

– reflux symptomsreflux symptoms– recurrent of symptoms - detection of recurrence recurrent of symptoms - detection of recurrence – removal of PEG tuberemoval of PEG tube

• Imaging Imaging – Post OT contrast study– Post OT contrast study (no consensus of interval - Day 2 to 3 months)(no consensus of interval - Day 2 to 3 months)


• No RCTNo RCT – rare disease rare disease (2.6/million/year)(2.6/million/year)

• Largest series – Teague Largest series – Teague et alet al in 2000 in 2000 – 36 patients were recruited36 patients were recruited

• Results:Results:– DiagnosticDiagnostic investigation: investigation: Ba contrastBa contrast (21/25) and (21/25) and upup

per endoscopyper endoscopy (18/21) (18/21)– Conservative Tx (5), open surgery (13), laparoscopic Conservative Tx (5), open surgery (13), laparoscopic

(18) – (18) – no major complications and deathno major complications and death– Median hospital stay: Median hospital stay: shorter in laparoscopicshorter in laparoscopic group group

than open group 6 Vs 14, than open group 6 Vs 14, p< 0.05p< 0.05

• No RCTNo RCT – rare disease rare disease (2.6/million/year)(2.6/million/year)

• Largest series – Teague Largest series – Teague et alet al in 2000 in 2000 – 36 patients were recruited36 patients were recruited

• Results:Results:– DiagnosticDiagnostic investigation: investigation: Ba contrastBa contrast (21/25) and (21/25) and upup

per endoscopyper endoscopy (18/21) (18/21)– Conservative Tx (5), open surgery (13), laparoscopic Conservative Tx (5), open surgery (13), laparoscopic

(18) – (18) – no major complications and deathno major complications and death– Median hospital stay: Median hospital stay: shorter in laparoscopicshorter in laparoscopic group group

than open group 6 Vs 14, than open group 6 Vs 14, p< 0.05p< 0.05


• Laparoscopic approachLaparoscopic approach• 3-ports 3-ports • OrganoaxialOrganoaxial type type• NoNo diaphragmatic hernia and eventratio diaphragmatic hernia and eventratio

n of diaphragmn of diaphragm• Gastropexy Gastropexy

– 0-0-EthibonEthibon– 2 anchoring fundus to the diaphragm2 anchoring fundus to the diaphragm– 2 anchoring greater curve to the anterior ab2 anchoring greater curve to the anterior ab

dominal walldominal wall

• Laparoscopic approachLaparoscopic approach• 3-ports 3-ports • OrganoaxialOrganoaxial type type• NoNo diaphragmatic hernia and eventratio diaphragmatic hernia and eventratio

n of diaphragmn of diaphragm• Gastropexy Gastropexy

– 0-0-EthibonEthibon– 2 anchoring fundus to the diaphragm2 anchoring fundus to the diaphragm– 2 anchoring greater curve to the anterior ab2 anchoring greater curve to the anterior ab

dominal walldominal wall


• Follow up:Follow up:– Resume diet in D3Resume diet in D3– Contrast study in D2 Contrast study in D2

stomach in normal positionstomach in normal position

no gross abnormal configuration of stomachno gross abnormal configuration of stomach

• Follow up:Follow up:– Resume diet in D3Resume diet in D3– Contrast study in D2 Contrast study in D2

stomach in normal positionstomach in normal position

no gross abnormal configuration of stomachno gross abnormal configuration of stomach


ConclusionConclusionConclusionConclusion

• Chronic gastric volvulus is a Chronic gastric volvulus is a rarerare disease disease • Require high Require high index of suspicionindex of suspicion in diagno in diagno

sissis• PainPain and and vomitingvomiting are the main symptom are the main symptom

ss• Barium mealBarium meal is the most diagnostic tool is the most diagnostic tool• Can be safely treated by Can be safely treated by laparoscopic aplaparoscopic ap

proachproach

• Chronic gastric volvulus is a Chronic gastric volvulus is a rarerare disease disease • Require high Require high index of suspicionindex of suspicion in diagno in diagno

sissis• PainPain and and vomitingvomiting are the main symptom are the main symptom

ss• Barium mealBarium meal is the most diagnostic tool is the most diagnostic tool• Can be safely treated by Can be safely treated by laparoscopic aplaparoscopic ap

proachproach

The EndThe End Thank you Thank you

The EndThe End Thank you Thank you

Documents

Joint Hospital Grand Round Management of Chronic Gastric Volvulus Kenny K Y Yuen Tseung Kwan O Hospital 20th January, 2007 Kenny K Y Yuen Tseung Kwan O