Gastric volvulus unassociated with hiatal hernia.

Although para-oesophageal hiatal hernia is the commonest cause of gastric volvulus, other causes of gastric volvulus require emphasis and 16 cases of gastric volvulus unassociated with hiatal hernia are reported. Delayed presentation following diaphragmatic injury was common. It is recommended that a thoracolaparotomy be performed in these patients to facilitate reduction of the volvulus, and division of intrathoracic adhesions under direct vision. In the secondary type of gastric volvulus accurate diagnosis is mandatory. Failure to recognize and treat associated disease will result in recurrence of the volvulus. A rational approach to the management of gastric volvulus is proposed.