The management of gastric volvulus in elderly patients.
BACKGROUND
Gastric volvulus is torsion of the stomach and requires immediate treatment. The optimal treatment strategy for patients with gastric volvulus is not established, because of significant variations in the cause and clinical course of this condition.


METHODS
We describe our experience with six elderly patients with gastric volvulus caused by different conditions using various approaches. This includes two patients managed with endoscopic reduction, followed by endoscopic or laparoscopic gastropexy.


CONCLUSIONS
Endoscopy is a necessary first step to determine the optimal treatment strategy, and endoscopic reduction is often effective. The indications for surgical repair of gastric volvulus depend on the patient's overall condition, and several options are available. In some elderly patients with severe comorbidities, major surgery may have an unacceptably high risk. We propose a novel treatment strategy for gastric volvulus in the elderly and a review of the literature.


CONCLUSIONS
Early endoscopy is necessary in patients with gastric volvulus. Endoscopic or laparoscopic gastropexy may be adequate therapy in selected elderly patients.
Department of Surgery, Yuki Hospital, Yuki 9629-1, Yuki City, Ibaraki, Japan. Electronic address: th-zuiki@jichi.ac.jp.
Toru
T
Zuiki
Department of Surgery, Jichi Medical University, Yakushiji 3311-1, Shimotsuke City, Tochigi, Japan.
Yoshinori
Y
Hosoya
Department of Surgery, Jichi Medical University, Yakushiji 3311-1, Shimotsuke City, Tochigi, Japan.
Alan Kawarai
AK
Lefor
Department of Surgery, Koganei Chuo Hospital, Koganei 2-4-3, Shimotsuke City, Tochigi, Japan.
Hiroyuki
H
Tanaka
Department of Surgery, Yuki Hospital, Yuki 9629-1, Yuki City, Ibaraki, Japan.
Toshihide
T
Komatsubara
Department of Surgery, Yuki Hospital, Yuki 9629-1, Yuki City, Ibaraki, Japan.
Yuzo
Y
Miyahara
Department of Surgery, Jichi Medical University, Yakushiji 3311-1, Shimotsuke City, Tochigi, Japan.
Yukihiro
Y
Sanada
Department of Surgery, Yuki Hospital, Yuki 9629-1, Yuki City, Ibaraki, Japan.
Jun
J
Ohki
Department of Surgery, Nasu Minami Hospital, Chuo 3-2-13, Nasukarasuyama City, Tochigi, Japan.
Chuji
C
Sekiguchi
Department of Surgery, Jichi Medical University, Yakushiji 3311-1, Shimotsuke City, Tochigi, Japan.
Naohiro
N
Sata
Case report; Endoscopic reduction; Esophageal hiatal hernia; Gastric volvulus; Gastropexy; Laparoscopic surgery