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


CONCLUSIONS
Symptomatic recurrence of chronic GV is very common although serious complications infrequently occur with conservative management. Peritoneal adhesion is independently associated with recurrence.
Hsu
Yao-Chun
YC
Division of Gastroenterology, Department of Medicine, Changhua Christian Hospital 135 Nanxiao St., Changhua City, Changhua 50006, Taiwan, China.
Perng
Chin-Lin
CL
Chen
Chun-Ku
CK
Tsai
Jai-Jen
JJ
Lin
Hwai-Jeng
HJ
D015746:Abdominal Pain / Q000209:etiology; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008019:Life Style; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D012307:Risk Factors; D055502:Secondary Prevention; D013277:Stomach Volvulus / Q000150:complications / Q000628:therapy*; D016896:Treatment Outcome
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