Chronic Gastric Volvulus

Abstract

GASTRIC volvulus may be defined as an abnormal anterior or posterior rotation of part or almost all of the stomach about either the coronal or the sagittal axis of the body. The stomach, being fixed by the gastrophrenic ligaments above and by the peritoneum covering the second portion of the duodenum below, is limited in mobility between these fixed points only by the length of the lesser curvature and the length of the gastrohepatic omentum, and may be displaced within these limits by extrinsic pressure from whatever cause. Pressure displacement of the stomach is, therefore, very common, but actual rotation of a part or almost all of the stomach is relatively rare and would seem to require unusually long gastrohepatic and gastrocolic mesenteries to allow of its occurrence. While the present discussion deals primarily with chronic or recurring volvulus, a brief consideration of the operative and postmortem findings in acute volvulus helps one to appreciate the anatomical arrangement and some of the probable causes of chronic volvulus. This interesting condition is not of recent discovery, being first described by Berti (3), in 1886, who found the condition at autopsy. He described a forward and upward rotation of the entire stomach, with the exception of the subdiaphragmatic portion of the fundus, through an angle of 180°, so that the greater curvature lay uppermost against the diaphragm. In 1909, Payer (14) found 22 cases of acute gastric volvulus in the literature and added 12 cases, while in 1914, Kocher (10) was able to find 28 cases and added one case. In 1921, Deaver and Ashurst (7) stated that volvulus of the stomach had apparently been observed in 35 cases and that there were on record at least 22 cases in which operations had been performed for gastric volvulus. In 1930, Buchanan (5) presented an excellent review of the literature and added one case, while other cases of acute gastric volvulus have been reported by Thorek (18), Nockolds (13), Gill (8), Kerr (9), and others. The earliest report of a case of chronic gastric volvulus is credited to Tuffier (19), who, in 1907, described the operative findings in a case of chronic partial gastric volvulus, the pyloric end only being involved. We are indebted to Rosselet (15) for the first report of a case of chronic gastric volvulus seen radiologically. In 1920, this observer reported a case of total organo-axial volvulus, seen fluoroscopically, in which the stomach was later found to be in normal position. The following year Rosselet and Gilbert (16) reported the first case of intermittent volvulus in which the finding was confirmed surgically. Since that time cases have been reported by Choisy and Babaiantz (6), Azmy and Marey (1), Myles (12), Shanks (17), and others. From the operative and autopsy findings reported in acute cases and from the radiological findings in the chronic cases observed, the following classification or grouping is suggested. 1. Type. (a) Organo-axial.