El vólvulo gástrico es una entidad poco frecuente pero potencialmente letal, caracterizada por la rotación del estómago sobre su eje, generalmente mayor a 180°, lo que puede ocasionar isquemia, necrosis y perforación. Afecta sobre todo a mayores de 50 años y se asocia con hernias hiatales tipo II o III.
Puede ser primario (idiopático) o secundario a alteraciones anatómicas, especialmente hernias paraesofágicas. Según el eje de rotación, se clasifica en organoaxial (más frecuente), mesenteroaxial, mixto y no clasificable.
La forma crónica se presenta con síntomas digestivos inespecíficos como plenitud, pirosis o vómitos. La forma aguda es una urgencia, con dolor epigástrico, vómitos no productivos y dificultad para pasar una sonda (tríada de Borchardt), con riesgo elevado de complicaciones.
El diagnóstico se basa en radiología, endoscopia y especialmente tomografía computarizada con contraste, que permite valorar la torsión y viabilidad gástrica.
El tratamiento incluye descompresión endoscópica inicial y cirugía definitiva para reducir la torsión y fijar el estómago. En pacientes de alto riesgo, pueden utilizarse técnicas mínimamente invasivas como gastropexia laparoscópica o endoscópica.
Gastric volvulus is a rare but potentially life-threatening condition, characterized by abnormal rotation of the stomach on its axis, typically exceeding 180°, which can lead to ischemia, necrosis, and ultimately gastric perforation. It predominantly affects individuals over the age of 50 and is frequently associated with type II or III hiatal hernias.
Gastric volvulus may be classified as primary (idiopathic) or secondary to anatomical abnormalities, most commonly paraesophageal hernias. Based on the axis of rotation, it is further categorized into organoaxial (the most prevalent form), mesenteroaxial, mixed, and unclassified types.
The chronic form usually presents with nonspecific gastrointestinal symptoms, such as early fullness, heartburn, or intermittent vomiting. In contrast, the acute form constitutes a surgical emergency, manifesting with epigastric pain, non-productive retching, and the inability to pass a nasogastric tube — a triad known as Borchardt’s triad — with a high risk of complications.
Diagnosis relies on imaging modalities, including plain radiography and endoscopy, though contrast-enhanced computed tomography (CT) is the gold standard, allowing precise assessment of the volvulus, gastric viability, and potential complications such as perforation.
Management involves initial gastric decompression followed by definitive surgical correction aimed at detorsion and gastric fixation. In high-risk or elderly patients, minimally invasive approaches such as laparoscopic or endoscopic gastropexy may be considered.