Difference between organo axial and mesentero axial volvulus
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Here is a thorough comparison of the two types of gastric volvulus.
Organoaxial vs. Mesenteroaxial Gastric Volvulus
Gastric volvulus is an abnormal rotation of the stomach >180° on its own axis, first described by Berti in 1866. Singleton's classification (the most widely used) divides it into three types based on the axis of rotation: organoaxial (Type I), mesenteroaxial (Type II), and combined/unclassified (Type III).
Schematic Diagrams
Fig. 53.8 - (a) Organoaxial, (b) Mesenteroaxial volvulus (Yamada's Textbook of Gastroenterology)
Fig. 27.5 - Pathogenesis of gastric volvulus: rows 1 = mesenteroaxial; rows 2-3 = organoaxial variants (Sleisenger & Fordtran's GI and Liver Disease)
Side-by-Side Comparison
| Feature | Organoaxial (Type I) | Mesenteroaxial (Type II) |
|---|---|---|
| Frequency | ~59-67% of cases (most common) | ~29-33% of cases |
| Axis of rotation | Long axis of stomach (longitudinal axis from GEJ to pylorus) | Short axis (transverse axis bisecting lesser and greater curvatures) |
| Direction of rotation | Stomach rotates along its length - antrum rotates anteriorly/superiorly, fundus posteriorly/inferiorly | Stomach folds on itself - antrum rotates anteriorly and superiorly; posterior surface faces anteriorly |
| GEJ and pylorus position | Both remain in their normal anatomical positions (not in close proximity to each other) | GEJ and pyloric/gastroduodenal junction come close together - "upside-down stomach" |
| Completeness | Usually complete (>180° twist) | Usually incomplete and intermittent |
| Presentation | Typically acute | Typically chronic/recurrent |
| Borchardt's triad | Classic - severe epigastric pain, retching without vomiting, inability to pass NG tube (occurs in ~70% of acute cases) | Less classical - NG tube passes more easily (lower esophageal sphincter remains open) |
| Vascular compromise/ischemia | High risk - strangulation and necrosis reported in 5-28% of cases | Uncommon - because rotation is usually incomplete |
| Obstruction type | Closed-loop obstruction | Obstruction less complete |
| Associated pathology | Strongly associated with paraesophageal/diaphragmatic hernia and diaphragmatic defects | Less associated with diaphragmatic defects; may occur without them |
| Radiologic appearance | Greater curvature displaced superiorly; lesser curvature more caudal | "Upside-down stomach" - distal antrum/pylorus positioned cranially to fundus (horizontal flip) |
| Surgical urgency | Usually emergency surgery required | May be managed on a non-emergency basis |
Key Points to Remember
Organoaxial - think "spinning a rolling pin" - the long axis is the pivot. The antrum and fundus rotate in opposite directions, creating a tight closed-loop. This is the dangerous type with high risk of ischemia and necrosis.
Mesenteroaxial - think "flipping a pancake" - the stomach folds over its midpoint. Because it's usually incomplete and intermittent, it tends to cause recurrent subacute symptoms rather than a surgical emergency.
Borchardt's triad (acute epigastric pain + retching without vomiting + inability to pass NG tube) is most characteristic of organoaxial volvulus. In mesenteroaxial, the NG tube passes relatively easily because the GEJ is not obstructed.
Combined type (Type III) - the stomach twists along both axes simultaneously; accounts for about 12% of cases and is most often seen in chronic volvulus.
Sources: Yamada's Textbook of Gastroenterology 7th ed., p. 1127-1128 | Sleisenger & Fordtran's GI and Liver Disease, p. 407 | Grainger & Allison's Diagnostic Radiology, p. 513 | Rosen's Emergency Medicine | Sabiston Textbook of Surgery
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