Volvulus of the stomach--an unusual cause of pulsus paradoxus

Pulsus paradoxus

OBJECTIVES

Reviewed the etiologies, pathophysiologic mechanisms, detection and clinical significance of pulsus paradoxus in various conditions.

DATA SOURCE

We searched PubMed, EMBASE, and the CINAHL from inception to June 2017. We used the following search terms: Pulsus paradoxus, pericardial effusion, acute asthma, ventricular interdependence and so forth. All types of study were chosen.

RESULTS AND CONCLUSION

Legendary physician Sir William Osler truly said that "Medicine is learned by the bedside and not in the classroom." Bedside history taking and physical examination should be an integral component of clinical teaching curriculum imparted to medical students. Pulsus paradoxus is a valuable physical sign seen in many clinical conditions. Pulsus paradoxus is defined by an inspiratory fall in systolic blood pressure of greater than 10 mm Hg. Two prototype examples of pulsus paradoxus are cardiac tamponade and acute asthma. Exaggerated swings of intrapleural pressure, bi-ventricular interactions and increase afterload of the left ventricle are few of the pathophysiological mechanisms involved in the causation of pulsus paradoxus. The sensitivity of pulsus paradoxus in the diagnosis of cardiac tamponade is very high. In acute asthma, it also correlates with the severity of airflow obstruction.

Acute gastric volvulus: case report and review of the literature

Gastric volvulus is a rare but potentially life-threatening cause of upper gastrointestinal obstruction. Emergency physicians must maintain a high index of suspicion in patients who present with signs and symptoms suggesting foregut occlusion. We report an illustrative case and review the pathogenesis, classification, diagnosis and treatment of this rare entity.

Organo-axial volvulus of the stomach with diaphragmatic eventration

Gastric volvulus occurs when the stomach rotates about its longitudinal axis (organo-axial volvulus), or about an axis joining the lesser and greater curvatures (mesentero-axial volvulus). Primary gastric volvulus, making up one third of cases, occurs when the stabilizing ligaments are too lax as a result of congenital or acquired causes. Secondary gastric volvulus, making up the remainder of cases, occurs in association with a paraesophageal hernia or other congenital or acquired diaphragmatic defects. While gastric volvulus may occur acutely, especially in children, it may not be clinically apparent and discovered incidentally. The authors present a case of chronic organo-axial volvulus of the stomach secondary to left hemidiaphragmatic eventration with a review of the relevant literature.

Gastric volvulus: two cases and a review of the literature

We report two cases of gastric volvulus. A discussion of the epidemiology, pathophysiology, clinical presentation, diagnosis, and treatment of this rare entity is presented.

Surgical results of intrathoracic gastric volvulus complicating hiatal hernia

From 1981 to 1988, 138 patients with hiatal hernia were treated surgically at our centre. Twenty-one (mean age 76.6 years, 17 women, four men) had an associated intrathoracic gastric volvulus. Eleven patients (mean age 73.2 years), of whom eight were asymptomatic, had an elective procedure. Ten patients (mean age 80.3 years) had emergency surgery, six for acute complications of the volvulus (five cases of strangulation and one of perforated ulcer) and four because of other, unrelated causes of acute abdomen. There were four deaths after operation, all in the emergency surgery group. Four other patients had significant morbidity, all in the emergency group. In the elective cases, all hernias were easily reduced. In one emergency case a gastrotomy was necessary for decompression, and in another gastrectomy was necessary because of gastric gangrene. Our results indicate the need for elective intervention when intrathoracic gastric volvulus is first diagnosed.