Gastric volvulus - the torsion of the stomach - may be mesenteroaxial, i.e. vertically-disposed, or organoaxial, i.e. horizontally. Most commonly, the colon shifts upwards under the diaphragm, often into an hiatal defect, and takes the stomach with it.
Clinically, it usually presents with nausea, vomiting, and retching, and it is noted on investigation that a nasogastric tube will not pass into the stomach. A chronic form may present more insidiously. Diagnosis is made by barium enema.
Emergency surgery is required if spontaneous reduction does not occur rapidly. The concern is that ischaemia will lead to gangrene and perforation. The greater curve of the stomach is freed from its colonic attachment. The risk of recurrence may be minimised by fixing the stomach, e.g. to the duodenojejunal flexure.
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