Gastrik Volvulus
Özet
Gastrik volvulus, midenin kendi uzun veya kısa ekseni etrafında anormal şekilde dönmesiyle karakterize, nadir görülen ve acil müdahale gerektiren klinik bir durumdur. Genellikle 50 yaş üstü yetişkinlerde diyafram anormallikleri veya paraözofageal herniler gibi sekonder nedenlere bağlı olarak gelişir. Midenin 180 dereceden fazla dönmesi tam obstrüksiyona, iskemiye, nekroza ve perforasyona yol açarak hayati risk oluşturur. Akut vakalarda şiddetli karın ağrısı, kusma ve nazogastrik tüp takılamaması ile karakterize Borchardt triadı klasik bir bulgudur. Tanıda bilgisayarlı tomografi ve düz batın grafileri kritik rol oynar. Tedavi sürecinin ilk basamağı sıvı resüsitasyonu ve nazogastrik ya da endoskopik yöntemlerle midenin dekompresyonudur. Kesin tedavi ise hastanın klinik durumuna göre şekillendirilen, laparoskopik veya açık cerrahi yöntemlerle midenin detorsiyonunu, anatomik defektlerin onarımını ve nüksü önlemek için gastropeksi uygulamasını içerir.
Gastric volvulus is a rare and life-threatening clinical emergency characterized by the abnormal rotation of the stomach along its longitudinal or transverse axis. It predominantly affects adults over the age of 50 and is frequently secondary to diaphragmatic defects or paraesophageal hernias. A rotation exceeding 180 degrees results in complete gastric outlet obstruction, compromising blood supply and potentially leading to tissue ischemia, necrosis, perforation, and abdominal sepsis. Acute presentations typically present with the classic Borchardt's triad, comprising severe epigastric pain, intractable vomiting, and the inability to pass a nasogastric tube. Diagnosis relies on radiological evaluations, particularly plain radiographs and computed tomography scans. Initial management focuses on fluid resuscitation, correcting electrolyte imbalances, and urgent gastric decompression via nasogastric tube or endoscopic guidance. Definitive treatment requires surgical intervention, either open or laparoscopic, to achieve stomach detorsion, repair underlying anatomical anomalies, and perform gastropexy to prevent recurrence.
Referanslar
Stavros G, Vasilis V, Stylianos G, et al. Acute gastric volvulus: diagnosis and management over 10 years. Digestive Surgery. 2006;23(3):169-72.
Rashid F, Thangarajah T, Mulvey D, et al. A review article on gastric volvulus: a challenge to diagnosis and management. International Journal of Surgery. 2010; 8:18.
Wasselle JA, Norman J. Acute gastric volvulus: pathogenesis, diagnosis, and treatment. American Journal of Gastroenterology. 1993 Oct;88(10):1780-4.
Sultan MA, Hakami AA, Alshabri MI, et al. Gastric Volvulus: A Rare Etiology of Acute Chest Pain. Cureus. 2021 Oct 26;13(10):e19067.
Wasselle JA, Norman J. Acute gastric volvulus: pathogenesis, diagnosis, and treatment. American Journal of Gastroenterology. 1993; 88:1780.
O'Gorman C S, Kiely P, Kenny B, et al. Acute gastric dilatation in a child with marked kyphoscoliosis and cerebral palsy a case report. Irish Medical Journal. 2005 Sep;98(8):242.
Traci E, Rubab H, Dana L Cr, et al. Gastric volvulus complication in an infant with undiagnosed congenital diaphragmatic hernia presenting with acute respiratory distress. Pediatric Emergency Care. 2012 Oct;28(10):1078-80.
Gupta V, Gupta P, Chandra A. Diaphragmatic eventration complicated by gastric volvulus with perforation. South African Journal of Surgery. 2012 Jul 11;50(3):90-1.
Carmen Payá-L, Aleix Martínez P, Segundo A G, et al. Laparoscopic management of gastric perforation secondary to mesenteroaxial volvulus in a patient with laparoscopic adjustable gastric banding. Asian Journal of Endoscopic Surgery. 2018 Nov;11(4):417-419.
Amr E, Merihan A E, Ahmed K A. Gastric volvulus after laparoscopic sleeve gastrectomy managed by conversion to Roux-en-Y gastric bypass. A case report and literature review. International Journal of Surgery Case Report. 2021 Dec;89:106609.
Milind J, Sandesh P, Beejal S, et al. Gastric volvulus in children: experience of 6 years at a tertiary care centre. African Journal of Paediatric Surgery. Jan-Apr 2010;7(1):2-4.
Kotobi H, Auber F, Otta E, et al. Acute mesenteroaxial gastric volvulus and congenital diaphragmatic hernia. Pediatric Surgery International. 2005; 21:674.
Zhijun W, Qiang Z, Yuanyuan H, et al. Wandering spleen with splenic torsion in a toddler: A case report and literature. Medicine (Baltimore). 2020 Sep 11;99(37):e22063
Franco V, Hazem H, Pamela T J, et al. Gastric volvulus: unraveling the diagnosis with MPRs. Emergency Radiology. 2019 Apr;26(2):221-225
Hemanta K N, Gaurav M, Neha K, et al. Delayed presentation of congenital diaphragmatic hernia presenting with intrathoracic gastric volvulus: a case report and review. BMJ Case Report. 2012 Nov 28;2012:bcr2012007332.
Ibáñez S, Borruel N, Cano A, et al. Gastrointestinal tract volvulus: diagnosis and correlation between plain-film X-ray and multidetector computed tomography findings. Radiologia. Jan-Feb 2015;57(1):35-43.
Raktim K G, Kulsoom F, Keyvan R, et al. Gastric volvulus: an easily missed diagnosis of chest pain in the emergency room. MJ Case Report. 2016 Jan 13;2016: bcr2015213888.
Deressa B K, Bruyninx L, Ngassa M, et al. Uncommon cause of retrosternal pain. Acta Gastroenterologica Belgica. Apr-Jun 2016;79(2):251-3.
Hsu YC, Perng CL, Chen CK, et al. Conservative management of chronic gastric volvulus: 44 cases over 5 years. World Journal of Gastroenterology. 2010; 16:4200.
Park W H, Choi S O, Suh S J. Pediatric gastric volvulus--experience with 7 cases. Journal of Korean Medical Science. 1992 Sep;7(3):258-63..
Foresti V, Villa A, Tagliaferri Gurney JW, et al. Sliding massive hiatal hernia: diagnosis using computerized axial tomography. Minerva Medica. 1987 Feb 15;78(3):171-4.
Al-Balas H, Hani MB, Omari HZ. Radiological features of acute gastric volvulus in adult patients. Clinical Imaging. 2010; 34:344.
Popescu R. Total gastrectomy performed in emergency conditions for gastric necrosis due to acute gastric dilatation. Chirurgia (Bucur). Jul-Aug 2013;108(4):576-9.
Lee S K, Raj S, Vivek S. Acute gastric volvulus with pneumatosis intestinalis and portal venous gas secondary to hiatus hernia induced gastric outlet obstruction. ANZ Journal of Surgery. 2019 Dec;89(12):E582-E583.
Gabriel A, Jordan W, Jonathan S. Acute Paraesophageal Hernia: Laparoscopic Repair With Adjunct T-Fastener Gastropexy for the High Operative Risk Patient. Surgical Laparoscopy Endoscopy Percutaneous& Techniques. 2018 Apr;28(2):123-127
Joseph Naim H, Robina S, Piotr J G. Emergent laparoscopic reduction of acute gastric volvulus with anterior gastropexy. Surgical Laparoscopy Endoscopy Percutaneous& Techniques. 2003 Dec;13(6):389-91.
Mangray H, Latchmanan NP, Govindasamy V, Ghimenton F. Grey's Ghimenton gastropexy: an anatomic make-up for management of gastric volvulus. Journal of The American College of Surgeons. 2008; 206:195.
Eckhauser M L, Ferron J P. The use of dual percutaneous endoscopic gastrostomy (DPEG) in the management of chronic intermittent gastric volvulus. Gastrointestinal Endoscopy. 1985 Oct;31(5):340-2.
Koger K E, Stone J M. Laparoscopic reduction of acute gastric volvulus. American Surgeon. 1993 May;59(5):325-8.
Ponsky J, Rosen M, Fanning A, et al. Anterior gastropexy may reduce the recurrence rate after laparoscopic paraesophageal hernia repair. Surgical Endoscopy. 2003 Jul;17(7):1036-41.
Karim MA, Maloney J, Ali A. Laparoscopic Repair of Intrathoracic Stomach: Clinical and Health-related Quality of Life Outcomes. Surgical Laparoscopy Endoscopy Percutaneous& Techniques. 2016; 26:484.
Jan H K, Jelmer E O, David J R, et al. Equal patient satisfaction, quality of life and objective recurrence rate after laparoscopic hiatal hernia repair with and without mesh. Surgical Endoscopy. 2017 Sep;31(9):3673-3680.
