Conservative management of chronic gastric volvulus: 44 cases over 5 years

Abstract

Aim: To investigate clinical outcomes of patients with chronic gastric volvulus (GV) who were managed conservatively over a 5-year period.

Methods: A total of 44 consecutive patients with chronic GV, as diagnosed by barium study between October 2002 and July 2008 were investigated. All of these patients received conservative management initially without anatomical correction. Their clinical manifestations, diagnostic work-ups, and clinical outcomes were analyzed. We sought to identify independent risk factors for poor outcome by using the Cox proportional hazards model.

Results: The enrolled patients were predominantly male (n = 37, 84%) and of advanced age (median: 71 years old, interquartile range: 57.5-78 years). Abdominal pain and fullness were the most common presentations. During the follow-up period (median: 16 mo, up to 69 mo), there was no severe complication, but symptomatic recurrence was noted in 28 patients (64%). Only one patient turned to elective surgery for frequent symptoms. Peritoneal adhesion was the only independent risk factor associated with recurrence (hazard ratio: 2.58, 95% CI: 1.08-6.13, P = 0.033).

Conclusion: Symptomatic recurrence of chronic GV is very common although serious complications infrequently occur with conservative management. Peritoneal adhesion is independently associated with recurrence.

Figure 1

Cumulative incidence of recurrence in 44 chronic gastric volvulus patients who were treated conservatively.

Figure 2

Peritoneal adhesion as a risk factor for symptom recurrence in patients with chronic gastric volvulus.