Conservative management of chronic gastric volvulus: 44 cases over 5 years

Table 1 Demographic and clinical characteristics of the study subjects

	Enrolled patients (n = 44)
Male sex, n (%)	37 (84)
Age, yr (IQR)	71 (57.5-78)
Duration between symptom onset and diagnosis, mo (IQR)	1 (0.5-6)
Symptoms, n (%)
Abdominal pain	25 (57)
Abdominal fullness	24 (55)
Non-cardiac chest pain	18 (41)
Nausea	17 (39)
Heartburn	10 (23)
Dyspnea	9 (20)
Acid regurgitation	9 (20)
Dysphagia	8 (18)
Vomiting	5 (11)
Hematemesis	2 (5)
Axis of volvulus, n (%)
Organoaxial	42 (95)
Mesenteroaxial	1 (2)
Mixed	1 (2)
Previous thoracic or abdominal surgery, n (%)	10 (22)
Secondary GV, n (%)	26 (59)
Duration of follow-up, mo (IQR)	16 (6-36)
Recurrence-free duration, mo (IQR)	3 (1-10.5)

IQR: Interquartile range; GV: Gastric volvulus.

Table 2 Probable etiology of secondary gastric volvulus n (%)

	Patients with secondary GV (n = 26)
Choledocholithiasis	9 (20)
Diaphragm defect	8 (18)
Diaphragm eventration	13 (30)
Gastric ulcer	9 (20)
Paraesophageal hernia	7 (16)
Peritoneal adhesion	11 (25)
Sliding hernia	10 (23)

Multiple predisposing factors for gastric volvulus (GV) might coexist in one patient.

Table 3 Performance of diagnostic modalities for gastric volvulus

	Ordered	Suggestive	Diagnostic	Unrevealing
Chest radiography	34	2	0	32
Abdominal radiography	30	2	0	28
Abdominal sonography	24	0	0	24
Upper GI endoscopy	25	6	2	17

GI: Gastrointestinal.

Table 4 Risk factors for symptom recurrence in patients with chronic gastric volvulus, as determined by log rank test

	Dichotomous variable	Patient number	Median recurrence-free period, mo (95% CI)	P value
Age (yr)	< 70/≥ 70	22/22	4 (2.2-5.8)/4 (2.9-5.1)	0.798
Sex	M/F	37/7	4 (2.2-5.8)/3 (0.4-5.6)	0.158
Delayed diagnosis1	Yes/no	20/24	2 (0.2-3.8)/24 (NA)	0.065
Presenting symptoms
Abdominal fullness	Yes/no	24/20	2 (0.6-3.4)/5 (3.0-7.0)	0.101
Abdominal pain	Yes/no	25/19	4 (2.5-5.5)/4 (0-27.0)	0.751
Acid regurgitation	Yes/no	9/35	5 (1.5-8.5)/4 (2.7-5.3)	0.680
Non-cardiac chest pain	Yes/no	18/26	2 (0.6-3.4)/5 (3.6-6.4)	0.096
Dysphagia	Yes/no	8/36	3 (0-7.2)/4 (2.9-5.1)	0.620
Dyspnea	Yes/no	9/35	4 (NA)/4 (2.6-5.4)	0.218
Heartburn	Yes/no	10/34	2 (0-4.1)/4 (2.3-5.7)	0.079
Nausea	Yes/no	17/27	5 (2.9-7.1)/4 (2.8-5.2)	0.810
Vomiting	Yes/no	5/39	4 (1.9-6.1)/4 (2.3-5.7)	0.580
Hematemesis	Yes/no	2/42	2 (NA)/4 (2.4-5.6)	0.332
Previous thoracic or abdominal surgery	Yes/no	10/34	3 (2.1-3.9)/5 (3.3-6.7)	0.061
Reflux esophagitis	Yes/no	14/30	4 (2.2-5.8)/4 (1.7-6.2)	0.466
Diaphragm eventration	Yes/no	13/31	3 (0.6-5.4)/5 (3.0-7.0)	0.126
Diaphragm defect	Yes/no	8/36	4(2.7-5.3)/4 (2.4-5.6)	0.755
Paraesophageal hernia	Yes/no	7/37	4 (1.4-6.6)/3 (1.4-4.6)	0.828
Sliding hernia	Yes/no	10/34	4 (2.5-5.5)/3 (0.4-5.3)	0.510
Peritoneal adhesion	Yes/no	11/33	1 (0-2.0)/5 (3.3-6.7)	0.015
Choledocholithiasis	Yes/no	9/35	2 (0.5-3.4)/4 (2.7-5.3)	0.101
Diabetes mellitus	Yes/no	5/39	1 (NA)/4 (1.9-6.1)	0.307
Gastric ulcer	Yes/no	9/35	4 (1.1-6.9)/4 (1.8-6.2)	0.926

¹NA: Not applicable (95% CI could not be calculated as a result of small sample size).