Acute and chronic gastric volvulus: radical different prognosis and management. Case report.

Gastric volvulus is an uncommon entity. Management is principally surgical. Diagnosis is often delayed because of the non-specific nature of the symptoms. The authors report two cases of gastric volvulus seen in a six month period. The first is an acute presentation diagnosed by computed tomography with incarceration and necrosis of the stomach, the transverse colon and great omentum. The issue was immediate laparotomy for total gastrectomy, colectomy, terminal colostomy and omentectomy. The patient survived, and the colostomy was closed and continuity restored three months later. The second one is a chronic form diagnosed by gastroscopy and barium swallow radiography. The treatment was elective with closure of the hiatus, Nissen procedure and gastropexy. The pathophysiology, classification and treatment of those two kinds of volvulus are briefly reviewed.