A A P B S Mesenteroaxial gastric volvulus and wandering spleen

Gastric volvulus twisting of all or part of the stomach more than 180 degrees (closed loop obstruction)  obstruction of the flow of material, variable loss of blood supply  possible tissue death  classic triad (70% of cases) ① severe epigastric pain ② retching without vomiting ③ inability to pass a nasogastric tube Can occur in any age, more common in children M=F

Gastric volvulus Three classification 1. Organoaxial type (m/c/ type, 59%) stomach rotates around an axis, GE junction – pylorus (long axis) Antrum rotates – anterosuperiorly Fundus rotates – posterinferiorly GC – superiorly, LC – inferiorly usually associated with diaphragmatic defects Strangulation and necrosis commonly occur (5-28%)

Gastric volvulus Three classification 2. Mesentericoaxial type (29%) bisects the lesser and greater curvatures (short axis) Antrum rotates anteriorly and superiorly, right to left Posterior surface of the stomach lies anteriorly Rotation  usually incomplete and occurs intermittently Vascular compromise is uncommon.

Gastric volvulus Three classification 2. Mesentericoaxial type (29%)

Gastric volvulus Three classification 3. Combined type Rare form, twists mesentericoaxially and organoaxially makes up the remainder of cases, usually chronic volvulus

Gastric volvulus Treatment  derotation, internal fixation, repair diaphragmatic defect Nonoperative mortality rate = as high as 80% Mortality rate from acute gastric volvulus = 15-20% Mortality rate from chronic gastric volvulus <13%

Wandering spleen Spleen migrates from its usual anatomical position Incidence : <0.5% Can cause intermittent torsion Abnormality of its suspensory ligaments  Gastric volvulus and wandering spleen share a common cause –absence of the spleen in the left upper quadrant –ovoid or comma-shaped abdominal mass w splenic vessels –enlarged spleen, with minimal or no enhancement (infarction)

References –World J Gastroenterol 2008 :7; –RadioGraphics 2011;31:1379–1402 –AJR 2009; 192:431–437 –World J Gastroenterol 2006;12: –Am J Surg Pathol 2007;31: –Radiology 2007; 242:791–801