J Korean Surg Soc.  2013 Jul;85(1):47-50.

Acute gastric volvulus treated with laparoscopic reduction and percutaneous endoscopic gastrostomy

• Jeong SH
• Ha CY
• Lee YJ
• Choi SK
• Hong SC
• Jung EJ
• Ju YT
• Jeong CY
• Ha WS

Abstract

Acute gastric volvulus requires emergency surgery, and a laparoscopic approach for both acute and chronic gastric volvulus was reported recently to give good results. The case of a 50-year-old patient with acute primary gastric volvulus who was treated by laparoscopic reduction and percutaneous endoscopic gastrostomy is described here. This approach seems to be feasible and safe for not only chronic gastric volvulus, but also acute gastric volvulus.

Keyword

Stomach volvulus; Intestinal volvulus; Laparoscopy; Endoscopy; Gastrostomy

MeSH Terms

Emergencies
Endoscopy
Gastrostomy
Humans
Intestinal Volvulus
Laparoscopy
Stomach Volvulus

Figure

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  Fig. 1 The simple abdominal X-ray and endoscopic images at presentation. (A) X-ray image in the abdominal erect view showing the distention and air-fluid levels in the stomach. (B) X-ray image in the supine view showing the distended and mass-like lesion in the epigastric area. (C) Endoscopic image showing the congested and edematous gastric wall.

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  Fig. 2 Schematic depiction of the gastric volvulus of the patient and preoperative abdominal computed tomography (CT) images in the coronal view. (A) The stomach had rotated (gray arrow) along the axis (dot line) joining the mid and lesser curvatures (mesentero-axial volvulus). The meaning of arrows 1, 2, and 3 are indicated in the legends of Fig. 2B and 2C. (B) CT image. Arrow ① indicates the esophagus and gastroesophageal junction, while arrow ② shows the body portion is superior to the fundus area. (C) CT image. Arrow ③ shows the gastric low body is located below the diaphragm and is connected to the duodenum.

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  Fig. 3 Intraoperative findings and postoperative upper gastrointerstinal study. (A) Depiction of the abdomen showing the placement of the four trocars (marked by circles; two 11-mm and two 5-mm ports). The position of the percutaneous endoscopic gastrostomy (PEG) is shown by the red star. (B) Before the reduction, blood stains were observed in the greater omentum along with a mass-like twisted stomach below the diaphragm. (C) After the reduction, normal stomach anatomy was observed. (D) Laparoscopic view of the PEG that had been inserted in the midbody greater curvature side. (E) Endoscopic view of the inserted PEG. (F) The postoperative upper gastrointestinal contrast study confirmed complete reduction of the stomach and the absence of evidence of obstruction. GC, greater curvature.

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  Fig. 4 Photos of the postoperative wounds. (A) On the fourteenth postoperative day, the percutaneous endoscopic gastrostomy (PEG) was still inserted. The port site wounds are indicated by blue circles. (B) The abdomen 5 months after the initial operation.

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