'Back-and-Forth Stomach' CT Imaging Findings of a Pathophysiologic Entity Causing Acute Gastric Volvulus.

Antonio Jesús Láinez Ramos-Bossini,Eduardo Ruiz Carazo,María Dolores Rabadán Caravaca

doi:10.3390/tomography8010019

Antonio Jesús Láinez Ramos-Bossini, Eduardo Ruiz Carazo

Open Access

https://doi.org/10.3390/tomography8010019

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Abstract

Background: Gastric volvulus (GV) is a life-threatening emergency condition that prompts emergent surgical management. With the advent of high-resolution computed tomography (CT), the role of radiologists in its diagnosis has become essential. Although many cases of GV have been described in the literature, its pathophysiology is still poorly understood. In addition, there is substantial terminological confusion with associated entities such as paraesophageal hernia, upside-down stomach, organo-axial or chronic GV. Methods: We conducted a retrospective review of clinical, radiological findings and other relevant data for seven patients with previous radiological diagnoses of a large hiatus hernia who presented with acute GV to the emergency department of our institution. We report data on age, sex, medical history, clinical presentation, imaging, treatment and outcomes for each case. Results: The CT findings at acute presentation showed the antrum lying above the diaphragm and dilated fundus below the diaphragm. By comparing the position of the stomach at acute presentation with previous imaging examinations, we confirmed a hypothesis put forward by a few authors decades ago that re-herniation of the gastric fundus into the abdomen is a common pathophysiologic trigger leading to acute GV. This hypothesis has not been supported by modern imaging examinations. Conclusions: We have provided imaging evidence supporting that the pathophysiology of many GVs is based on caudal re-descent of hiatal hernia into the abdominal cavity. Given the terminological disparity used in the literature in this context, we believe it appropriate to introduce and extend the term ‘back-and-forth stomach’ to refer to this type of GV.

Highlights

Accepted: 18 January 2022Gastric volvulus (GV) is a rare complication secondary to twisting of the stomach more than 180◦ around its own axis, either transversally or longitudinally, resulting in a closed-loop obstruction [1,2,3,4]
We describe a series of acute GV occurrences diagnosed by computed tomography (CT) which were caused by re-herniation of previous large hiatal hernias (HHs) into the abdomen
HHs were diagnosed with CT, one with PET-CT, one with barium swallow and one with conventional radiography (CR)

Summary

Introduction

Gastric volvulus (GV) is a rare complication secondary to twisting of the stomach more than 180◦ around its own axis, either transversally or longitudinally, resulting in a closed-loop obstruction [1,2,3,4]. The first reports of this entity date back to the end of the 19th century [5]. Numerous case reports and series have been published, contributing to a better understanding of GV. Because the clinical presentation of GV is nonspecific, imaging examinations are required for appropriate diagnosis. Multidetector computerized tomography (MDCT) scanners offer excellent temporal and spatial resolution with multiplanar reformatting capability, high image quality and diagnostic reliability. MDCT is currently considered the ‘gold standard’ in the diagnosis of GV [10,11]

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