Radiology Resident Case of the Week
Etiology/Pathophysiology
An uncommon condition with abnormal rotation or torsion of one part of the stomach upon the other. Occurs at any age secondary to laxity of suspensory gastric ligaments.
Pathology:
Usually occurs in conjunction with paraesophageal hernias in the elderly, permitting partial or complete intra-thoracic position of the stomach. In children it is associated with traumatic diagphragmatic hernia.
Miscellaneous
Two Types
1. Organoaxial: Refers to rotation of the stomach upward,
around its long axis (a line connecting the cardia to the
pylorus). the antrum moves from an inferior to a
superior position. Common in the elderly.
2. Mesentaroaxial: The stomach rotates from right to left
or left to right about the long axis of the gastrohepatic
omentum (a line connects the middle of the lesser
curvature with the middle of the greater curvature).
Common in children.
Imaging
plain film abd and upper GI. Double air fluid level on upright. Inversion of stomach with the greater curvature above the level of the lesser or positioning of the cardia and the pylorus at the same level
and downward pointing of the pylorus and duodenum.
DDX
Gastric atony , Pyloric obstruction, Acute gastric dilation, Gastric volvulus
Key references
1. Gastrointestinal Radiology A Pattern Approach.
2nd Ed, R.L. Esinberg. pge 286. J.B. Lippincott Co. 1990 NY
2. Gastrointestinal Imaging. R.K. Gedgaudos-McClees. pge. 64. Churchill Livingstone. 1987 NY
3. Gastrointestinal Imaging in Pediatrics. 2nd ed. E.A> Franken JR. pge 116 Harper and Row Pub. 1982.
ACR Code
728.1462
Keywords:
volvulus, mesentaroaxial