Organoaxial gastric volvulus
By Rajiv K. Tangri, DO and Bina L. Chaddha, MD
An admission chest X-ray revealed a hiatal hernia (Figure 1). A
lateral view from the upper GI series showed a hiatal hernia, with
components of a sliding and a paraesophageal hernia (Figure 2). The
frontal view from the upper GI series shows a significant component
of the greater curvature to be intrathoracic in location (Figure
3). The greater curvature of the stomach is superior to the lesser
curvature of the stomach. The antrum is also superior to its
expected inferior position. An additional frontal view shows no
evidence of obstruction (Figure 4).
There are 2 major types of gastric volvulus, organ-oaxial and
mesenteroaxial. In an organoaxial volvulus, the stomach rotates on
its longitudinal axis (from cardia to pylorus).1
mesenteroaxial volvulus, the stomach rotates around the
gastrohepatic omentum in a left/right or right/left
If this occurs acutely, patients become
symptomatic from vascular compromise or gastric outlet obstruction
with the classic Borchardt's triad (severe epigastric pain and
distention, vomiting then retching without production of any
vomitus, and difficulty or inability to pass a nasogastric tube).
If vascular compromise occurs, there is a 30% mortality
In addition to the 2 major types of gastric volvulus, gastric
volvulus can be classified as primary or secondary.3 In
the primary form, there is no diaphragmatic defect. In the
secondary, the more common form, a diaphragmatic defect is
present.3 Organoaxial volvulus is more common in the
elderly and is the result of ligamentous laxity.4
Patients often have a long-standing hiatal hernia, and severe
symptoms are rare.5 Radiological signs of gastric
volvulus include a double air-fluid level on upright films,
inversion of the stomach with the greater curvature above the level
of the lesser curvature, positioning of the cardia and pylorus at
the same level, and downward pointing of the pylorus and
Gastric volvulus is a life-threatening emergency. In patients
with a clinical history of abdominal or chest pain, retching
without vomiting, and the finding of a hernia, the diagnosis should
be excluded. When there has been complete volvulus, a nasogastric
tube cannot be passed and rapid therapy should be sought.
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- Campbell JB, Rappaport LN, Skerker LB. Acute mesentero-axial
volvulus of the stomach. Radiology. 1972;103:153-156.
- Carter R, Brewer LA 3rd, Hinshaw DB. Acute gastric volvulus. A
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- Ajao OG. Gastric volvulus: A case report and a review of
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- Scott RL, Selker R, Rimer-Muram H, et al. The differential
cardiac air fluid level: A sign of intrathoracic gastric volvulus.
J Can Assoc Radiol. 1986;37:119-121.
- Eisenberg RL. Gastric volvulus. In: Gastrointestinal
Radiology.A Pattern Approach. Philadelphia, Pa: JB Lippincott;
- Menuck L. Plain film findings in gastric volvulus herniating
into the chest. AJR Am J Roentgenol.1976;126:1169-1174.
Organoaxial gastric volvulus.
March 20, 2007