Organoaxial Volvulus of the Stomach

Howard T Heller, MD
Harry Z Mellins, MD

April 16, 1996

Presentation

A 57-year-old man with a history of gastritis presented to the clinic with dysphagia and chest discomfort.

Imaging Findings

Contrast-enhanced radiograph of the abdomen

An upper gastrointestinal examination revealed the stomach to have an unusual orientation. This prone film shows the contrast-filled gastric fundus (arrow) to be flipped inferiorly with the greater curvature superior to the lesser curvature.

Diagnosis

Organoaxial volvulus of the stomach

Discussion

Organoaxial volvulus occurs when the stomach twists upon itself--frequently in association with a hiatal hernia--allowing the stomach to become an intrathoracic organ. In organoaxial volvulus, the stomach rotates around its long axis (cardia to pylorus) with the greater curvature flipped medially in vertical stomachs and superior to the lesser curvature in transverse stomachs, as in this case. Organoaxial volvulus is more common in the elderly and is caused by ligamentous laxity. Often, a long-standing hiatal hernia is present and severe symptoms are unusual.

In a similar condition, mesenteroaxial volvulus, the stomach rotates around the gastrohepatic omentum (mid-lesser curvature to mid-greater curvature) in a left/right or right/left direction. Symptoms result from vascular compromise or gastric outlet obstruction, with the classic triad of retching producing little vomitus, severe abdominal pain and inability to successfully pass a nasogastric tube. With vascular compromise, mortality is 30%.

References

1. Taveras JM, Ferrucci JT. Radiology diagnosis-imaging-intervention. Philadelphia: JB Lippincott Co, 1994; 4(20):1-7.

2. Gore RM, Levine MS, Laufer L. Textbook of gastrointestinal radiology. Philadelphia: WB Saunders Co, 1994; 735.

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