MDCT appearance of Organoaxial, Mesenteroaxial Types of Gastric Volvulus

Abstract

Introduction: Gastric volvulus is a rare cause of acute or recurring abdominal pain in adults, with significant mortality and morbidity. Gastric volvulus is rotation of stomach along its axis, causing gastric outlet obstruction and can result in ischaemia and infarction. Aim: Evaluation of differentiating findings of organoaxial, and mesenteroaxial types of gastric volvulus on Multidetector Computed Tomography (MDCT). Materials and Methods: This was a retrospective study of 20 cases of radiologically suspected cases of gastric volvulus, extracted by keyword search (gastric volvulus) from our reviewed Teleradiology RIS/PACS between the periods Nov-2014 to May-2017. The age group, gender and presenting symptoms of cases were evaluated and statistically analysed. Differentiating CT features of organoaxial volvulus and mesenteroaxial volvulus were evaluated and analysed. Results: In our study, 80% cases were of the organoaxial type of gastric volvulus, while the remaining 20% were of mesenteroaxial type. Mean age of presentation was 77 years with higher incidence among older population. 65% of the patients in our study were females. The majority (85%) in our series presented with classical abdominal pain, nausea and vomiting, and the presence of a hiatal hernia. In our series MDCT was helpful in diagnosing gastric volvulus based on abnormal axis of rotation (100% of both OAV and MAV) and abnormal location of the pyloric antrum above the fundus (85% of OAV). Pylorus lying above the gastroesophageal junction is a differentiating feature (100% of cases of MAV). Conclusion: MDCT is useful in diagnosing gastric volvulus as well as in differentiating OAV and MAV types by specific findings such as axis of rotation of the stomach, position of GEJ, pylorus, greater and lesser curvatures.

Keywords

• fundus
• gastro-esophageal junction
• mesenteroaxial volvulus
• organoaxial volvulus
• pyloric antrum
• pylorus