Combined endoscopic and laparoscopic management of chronic gastric volvulus

Gastric volvulus may be d efined as an abnormal rotation of one portion of the stomach a round itself.1 It is a rare condition that may lead to an impairment of the vascular supply to the stomach in the a cute setting. Anatomic changes needed for development of volvulus include laxity of the gastrohepatic, gastroduodenal, gastrosplenic, and gastrocolic ligaments. The critical ligaments preventing volvulus are the latter two, as described by Dalgaard 2 in a series of 150 patients. Traditional management of chronic volvulus has been w ith laparotomy and anterior gastropexy. P atients who present with this condition and serious concomitant medical conditions, however, may be at increased risk of anesthetic and postoperative pulmonary complications. We discuss the u se of combined laparoscopy to reduce a volvulus and flexible endoscopy to aid in suture placement in two patients whose volvuli were not able to be reduced by gastroscopy.