Gastric volvulus is an abnormal rotation of the stomach of more than 180°, which creates a closed-loop obstruction that can result in incarceration and strangulation.  It can manifest either as an acute abdominal emergency or as a chronic intermittent problem. The presenting symptoms depend on the degree of twisting and the rapidity of onset. Gastric volvulus is a rare condition. It is a difficult condition to diagnose, mostly because it is rarely considered.

The Borchardt triad (i.e., pain, retching, and inability to pass a nasogastric tube) is diagnostic of acute volvulus and reportedly occurs in 70% of cases [i]. The most frequently used classification system of gastric volvulus, proposed by Singleton [ii] relates to the axis around which the stomach rotates and includes the following three types

• Organoaxial
• Mesenteroaxial
• Combined

In etiologic terms, gastric volvulus can be classified as either type 1 (idiopathic) or type 2 (congenital or acquired). In a primary gastric volvulus, there is the absence of abnormal intra-abdominal pathology and diaphragmatic defects[iii]. This kind of volvulus occurs as a result of a neoplasm, adhesions or abnormalities of the ligamentous attachments of the stomach.

A secondary gastric volvulus occurs as a result of abnormalities of gastric anatomy, motility or abnormalities of the diaphragm or spleen [iv]. Most cases of gastric volvulus have a secondary cause such as a para-oesophageal hernia, peptic ulcers, bariatric surgery, abdominal adhesions and traumatic diaphragmatic injury.[v] This kind of volvulus occurs as a result of a neoplasm, adhesions or abnormalities of the ligamentous attachments of the stomach.

A PubMed literature review was performed involving all cases of a gastric volvulus reported from 1999 to 2018 (total of 43 case-reports). Of those cases, 67% were due to a secondary cause, 91% of them were treated with surgery and death was recorded in three patients vi.