Gastric volvulus


  • Abnormal rotation of the stomach around its short or long axis
  • Rare but potentially life-threatening due to potential for untreated volvulus to progress to strangulation and cause gastric ischemia and perforation
  • Usually associated with paraesophageal hernia or diaphragmatic eventration[1]

Clinical Features

  • Usually appear relatively well until progressed to gastric ischemia
  • Abdominal pain/tenderness and distension, particularly upper abdomen
  • Vomiting, retching that often does not respond to antiemetics

Differential Diagnosis

Diffuse Abdominal pain

Epigastric Pain


  • Evaluate for other causes of pain
  • CXR may show retrocardiac air-filled gastric shadow[2]
  • Upright CXR and abdominal x-ray
    • Intrathoracic, upside-down stomach
    • Double air fluid level in stomach
    • Collapsed small bowel
  • CT abdomen most helpful
    • Gastric herniation around points of torsion
    • May show signs of gastric ischemia, seen a lack of contrast enhancement of gastric wall



  • Admit

See Also

External Links


  1. Wu MH, Chang YC, Wu CH, Kang SC, Kuan JT. Acute gastric volvulus: a rare but real surgical emergency. Am J Emerg Med. 2010;28(1):118.e5-7.