Department of Radiology, Virgen de las Nieves University Hospital, 18014 Granada, Spain.
Department of Radiology, Infanta Margarita Hospital, 14940 Cabra, Spain.
Tomography. 2022 Jan 21;8(1):245-256. doi: 10.3390/tomography8010019.
Gastric volvulus (GV) is a life-threatening emergency condition that prompts emergent surgical management. With the advent of high-resolution computed tomography (CT), the role of radiologists in its diagnosis has become essential. Although many cases of GV have been described in the literature, its pathophysiology is still poorly understood. In addition, there is substantial terminological confusion with associated entities such as paraesophageal hernia, upside-down stomach, organo-axial or chronic GV.
We conducted a retrospective review of clinical, radiological findings and other relevant data for seven patients with previous radiological diagnoses of a large hiatus hernia who presented with acute GV to the emergency department of our institution. We report data on age, sex, medical history, clinical presentation, imaging, treatment and outcomes for each case.
The CT findings at acute presentation showed the antrum lying above the diaphragm and dilated fundus below the diaphragm. By comparing the position of the stomach at acute presentation with previous imaging examinations, we confirmed a hypothesis put forward by a few authors decades ago that re-herniation of the gastric fundus into the abdomen is a common pathophysiologic trigger leading to acute GV. This hypothesis has not been supported by modern imaging examinations.
We have provided imaging evidence supporting that the pathophysiology of many GVs is based on caudal re-descent of hiatal hernia into the abdominal cavity. Given the terminological disparity used in the literature in this context, we believe it appropriate to introduce and extend the term 'back-and-forth stomach' to refer to this type of GV.
胃扭转（GV）是一种危及生命的紧急情况，需要紧急手术治疗。随着高分辨率计算机断层扫描（CT）的出现，放射科医生在其诊断中的作用变得至关重要。尽管文献中已经描述了许多 GV 病例，但它的病理生理学仍然知之甚少。此外，与食管裂孔疝、胃倒置、器官轴或慢性 GV 等相关实体之间存在大量术语混淆。
我们对我院急诊科 7 例既往影像学诊断为大裂孔疝的急性 GV 患者的临床、影像学表现及其他相关资料进行回顾性分析。我们报告了每个病例的年龄、性别、病史、临床表现、影像学表现、治疗和结果数据。
急性表现的 CT 结果显示胃窦位于膈肌上方，胃底扩张位于膈肌下方。通过比较胃在急性发作时和既往影像学检查时的位置，我们证实了几十年前少数作者提出的假设，即胃底再次疝入腹部是导致急性 GV 的常见病理生理触发因素。这一假设尚未得到现代影像学检查的支持。
我们提供了影像学证据，支持许多 GV 的病理生理学基于裂孔疝向腹腔内的尾部复位。鉴于文献中在这方面使用的术语差异，我们认为引入并扩展“来回胃”一词来指代这种类型的 GV 是合适的。
