From the Research
Acute gastric volvulus is a surgical emergency that requires immediate intervention with prompt surgical correction to prevent life-threatening complications, as evidenced by the most recent study 1. The patient should be stabilized with IV fluids, nasogastric tube decompression, and correction of electrolyte abnormalities before surgery.
- The definitive management is surgical detorsion of the stomach and prevention of recurrence through gastropexy, where the stomach is fixed to the abdominal wall.
- In cases with gastric necrosis, partial gastrectomy may be necessary.
- Laparoscopic approaches are increasingly used, but open surgery may be required in unstable patients or complex cases, as noted in 2. Post-operatively, patients need close monitoring for complications like bleeding, infection, or recurrence.
- Proton pump inhibitors such as pantoprazole 40mg daily should be administered to reduce gastric acid and promote healing, although the optimal dosage and duration may vary depending on the individual case.
- Patients typically require a period of nothing by mouth followed by gradual diet advancement. Acute gastric volvulus has a high mortality rate if left untreated due to potential complications including strangulation, ischemia, necrosis, and perforation, which underscores the importance of rapid diagnosis and treatment, as highlighted in 3 and 2. The use of endoscopic reduction, as described in 1, may be considered as a temporary measure, but surgical intervention is often necessary to prevent recurrence and complications. Overall, the management of acute gastric volvulus requires a multidisciplinary approach, with prompt surgical intervention being the cornerstone of treatment, as supported by the evidence from 4, 3, and 2.