The Two Ligaments Primarily Involved in Gastric Volvulus
The gastrosplenic and gastrophrenic ligaments are the two primary ligaments involved in gastric volvulus, as their laxity or absence allows abnormal rotation of the stomach around its axis. 1
Anatomical Basis of Gastric Volvulus
Gastric volvulus occurs when the stomach abnormally rotates around one of its axes. This pathology is fundamentally related to the failure of the stomach's supporting ligamentous structures:
- Gastrosplenic ligament - Connects the greater curvature of the stomach to the spleen
- Gastrophrenic ligament - Connects the stomach to the diaphragm
When these ligaments become elongated, weakened, or absent, the stomach becomes more mobile and prone to rotation. This ligamentous laxity is the principal predisposing factor for gastric volvulus 2, 1.
Types of Gastric Volvulus Based on Axis of Rotation
Gastric volvulus is classified according to the direction of rotation:
- Organoaxial volvulus - Rotation occurs around the longitudinal axis (connecting the cardia to the pylorus)
- Mesentericoaxial volvulus - Rotation occurs around an axis joining the lesser and greater curvatures 3, 4
Pathophysiology
The pathophysiology involves:
- Abnormal rotation of the stomach (>180°) around its axis
- Rotation leads to obstruction, which can progress to:
- Increased intraluminal pressure
- Decreased capillary perfusion
- Mural ischemia
- Potential strangulation, necrosis, and perforation 2
Clinical Significance
Understanding the involvement of these two ligaments is critical because:
- Their laxity is the primary anatomical factor allowing gastric volvulus to occur
- In surgical management, addressing these ligamentous attachments through gastropexy is often necessary to prevent recurrence 1, 5
- In congenital cases, particularly those associated with diaphragmatic defects, these ligaments may be congenitally absent or malformed 6
Diagnostic Considerations
When gastric volvulus is suspected, imaging studies should focus on:
- Abdominal CT (gold standard) showing a dilated stomach with the characteristic "whirl sign" representing the twisted stomach and its mesentery
- Plain radiographs may show an elevated gastric air-fluid level 1, 5
Early recognition of this condition is essential as acute gastric volvulus carries significant mortality risk if left untreated due to potential ischemia and perforation.