Abstracts

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1456. A New Twist to Gastric Rotation and Volvulus: A Multidisciplinary Approach
Authors * Denotes Presenting Author
  1. Clare Arroyo *; University of New Mexico
  2. Ujwal Chadha; University of New Mexico
  3. Tabitha Kirkehdall; University of New Mexico
  4. Herbert Davis; University of New Mexico
  5. Edward Auyang; University of New Mexico
  6. Steven Eberhardt; University of New Mexico
  7. William Thompson; University of New Mexico
Objective:
Investigate the reliability of CT findings and clinical symptoms differentiating patients with organo-axial volvulus (OAV) vs organo-axial rotation (OAR). Demonstrate that OAR is a more common clinical diagnosis than previously thought, rarely requiring surgery. Clarify the existing nomenclature between OAV and OAR.

Materials and Methods:
Clinical records were queried for patients with OAR and OAV in radiologic dictations from 1/1/13-12/31/18. 45 patients with CT imaging were selected. Five abdominal radiologists analyzed the CTs for presence or absence of sixteen secondary signs of volvulus (AJR 219: 212 103-108). Statistical analysis evaluated inter-observer agreement and the sensitivity of CT findings differentiating OAR from OAV. Analysis was performed to determine if any clinical indicators are diagnostic of OAV vs OAR. HRRC IRB approval was obtained (UNM HRRC #19-138).

Results:
True OAV occurred in 4 of 45 patients (8.9%), with 41 of 45 exhibiting OAR (91.1%). Among the radiologists, agreement of secondary CT signs was greater than 90% on all scales except for classification of OAV or OAR which had 67% agreement. We were unable to prove with statistical significance that any clinical symptom is predictive of OAV due to the small number of true OAV cases.

Conclusion:
Our findings supported that OAR is more prevalent than previously suggested in the literature and reaffirmed that OAR is more common than OAV. We were unable to definitively assess degree of gastric rotation radiologically, instead relying on the presence of secondary signs such as gastric outlet obstruction, peri-gastric fluid, and gastric ischemia to differentiate OAR and OAV. However, the presence of these secondary signs are still unreliable predictors of acute symptoms and need for urgent surgical intervention. We found that most patients had been living with OAR chronically, often acutely asymptomatic and not progressing to OAV. Although OAR and OAV are often used interchangeably radiologically, clinically, and in the literature these terms imply different severity of illness and clinical management. We seek to clarify that OAR is a chronic finding, and should be diagnosed as such radiologically, unless there are radiologic secondary signs or clinical symptoms to support a diagnosis of OAV.