gastric volvulus was first described by berti in 1866 based on the autopsy of a 61-year - old woman.1 there are three types of gastric volvulus : organoaxial ( most common ) , where abnormal torsion occurs on a stomach 's longitudinal axis ( line connecting the cardia and the pylorus along the luminal axis of stomach ) ; mesenteroaxial , where torsion occurs along a vertical axis ( from lesser curvature to greater curvature ) ; and a combination both the above types.2 the incidence is rare , approximately 20% of gastric volvulus cases occur in infants under 1 year old , and the other 80% in adults , among which 80% to 90% cases occur in the fifth decade of life.3 there is no reported association with sex or race . the symptoms of gastric volvulus vary depending on the degree of twisting and the rapidity of onset . rotation of the stomach more than 180 causes complete gastric outlet obstruction . a closed loop can cause strangulation of the stomach , which can lead to ischemia , necrosis , perforation , and abdominal sepsis . we report a case of a 79-year - old woman with chronic gastric volvulus treated with endoscopic decompression and laparoscopic gastropexy . a 79-year - old woman reported to the emergency center with a history of recurrent epigastric pain and nausea for 2 weeks . however , she had visited the emergency room previously with recurrent epigastric pain and nausea . there was no history of trauma . when reviewed , she denied any of the following : diaphoresis , shortness of breath , constipation , diarrhea , previous surgery , and use of non - steroidal anti - inflammatory drugs and alcohols . on physical examination , her vital signs were stable . laboratory testing revealed a moderately elevated white cell count of 14,500/ml with 91% segmented neutrophils . a plain abdominal radiograph revealed a large air bubble sign in the left upper abdomen ( fig . a contrast - enhanced abdominal computed tomography revealed a markedly distended stomach ; the transposition of the gastroesophageal junction and gastric antrum confirmed a recurrent or chronic state of mesenteroaxial gastric volvulus ( fig . a barium meal study revealed the presence of the antrum folded over 180 located above gastroesophageal junction ( single study ) . after the patient consumed a foaming agent for a double study , the gastric antrum and gastroesophageal junction returned to their normal position , the gastric antrum returning to its position above the gastroesophageal junction within 2 to 3 minutes . after insertion of an endoscope and gentle air insufflations on entering into the gastric lumen of the endoscope shaft , abnormal rotation of the gastric axis was observed . while removing the previously inserted endoscope , the axis recovered to the normal direction ( fig . after endoscopic reduction , the patient felt an improvement in her symptoms for about 24 hours . however , the symptoms recurred after that , due to which surgical treatment was planned . the spleen had no redundancy , but the 1st and 2nd duodenal portions showed redundancy . reduction of the gastric volvulus was performed with two laparoscopic graspers through traction of the greater curvature of the stomach . the greater curvature of the stomach was sutured to the abdominal wall by using laparoscopic suture techniques . the stomach was lifted up to the abdominal wall to check the optimal point of the gastropexy . four prolene 2 - 0 sutures were placed along the greater curvature of the stomach from 5 cm above the pylorus to the lower body . 11 blade to insert an endo - closure to bring out the prolene suture ( fig . the pneumoperitoneum was slightly released to 5 mmhg , and the prolene sutures were tied and firmly held in their positions without any excessive traction ( fig . 3b ) . on postoperative day 5 , an upper gastointestinal study confirmed reduction of the patient 's stomach ( fig . the patient did well in the postoperative period and was discharged at postoperative day 7 . she was followed up for 6 months and showed no evidence of recurrence , either radiological or symptomatic . gastric volvulus is defined as an abnormal rotation of the stomach of more than 180 , creating a closed - loop obstruction and resulting in incarceration and strangulation.4 congenital diaphragmatic hernia , paraesophageal hernia , and wandering spleen are the main secondary causes of this condition.4 more commonly , secondary volvulus occurs due to diaphragmatic defects or other intraabdominal factors such as left diaphragmatic eventration , adhesions , gastric ulceration , and gastric or duodenal carcinoma.5 in our case , there was no predisposing factor accompanying gastric volvulus , which is very rare . chronic gastric volvulus is typically characterized by intermittent epigastric pain and abdominal fullness after meals.6 the borchardt triad ( severe epigastric pain and distention , vomiting followed by violent retching without the ability to vomit , and difficulty or inability to pass a nasogastric tube ) is the key diagnostic feature of acute volvulus which occurs in 70% of cases.7 the basic surgical dictum for the treatment of gastric volvulus includes decompression of the stomach with reduction of the volvulus , gastropexy , and correction of the intra - abdominal factors predisposing to volvulus.5 tanner8 described the various methods of surgical repair for gastric volvulus . these include gastrojejunostomy , fundo - antral gastrogastrostomy ( opolzer 's operation ) , partial gastrectomy , division of bands , repair of diaphragmatic hernia , simple gastropexy , gastropexy with division of the gastrocolic omentum ( tanner 's operation ) , and repair of eventration of the diaphragm . endoscopic gastropexy with a gastrostomy tube can be used to decrease the incidence of recurrent volvulus . however , eckhause and ferron9 reported that a solitary percutaneous endoscopic gastrostomy ( peg ) tube can create a new point of fixation for the recurrent volvulus . koger and stone10 reported an acute organoaxial gastric volvulus with paraesophageal hernia treated with laparoscopic reduction followed by broad gastropexy using three pull - type peg tubes . gastric volvulus with large paraesophageal hernias can be managed laparoscopically as well.12 in conclusion , after endoscopic maneuvering to reduce acute symptoms , laparoscopic gastropexy represents a safe and feasible approach to treating gastric volvulus . elderly patients may have potential benefits such as minimal morbidity and shorter hospital stay after undergoing laparoscopic gastropexy . long - term studies are needed to document whether laparoscopic gastropexy alone would be a gold standard for treating chronic gastric volvulus without hiatal hernia .
gastric volvulus is an uncommon clinical entity . 
 there are three types of gastric volvulus ; organoaxial , mesenteroaxial and combined type 
 . this condition can lead to a closed - loop obstruction or strangulation . 
 traditional surgical therapy for gastric volvulus is based on an open approach . here 
 we report a successful case of a patient with chronic gastric volvulus with a laparoscopic treatment . 
 a 79-year - old woman came to the emergency department with epigastric pain accompanied by nausea for 2 weeks . 
 abdominal computed tomography revealed markedly distended stomach with transposition of gastroesophageal junction and gastric antrum . 
 barium meal study revealed presence of the antrum was folded over 180 degrees that was located above gastroesophageal junction . 
 we attempted an endoscopic reduction , but it was unsuccessful . 
 the patient got laparoscopic anterior gastropexy . 
 based on our result , laparoscopic gastropexy can be considered as a good choice of the treatment for gastric volvulus .