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Gastric volvulus and the upside-down stomach.

Gastric volvulus may present acutely with Borchardt's triad or with chronic vague abdominal symptoms. Predisposing factors include lax ligaments, bands, adhesions, paraesophageal diaphragmatic hiatus hernia, and eventration of the diaphragm. The goals of surgery are to detorse the stomach, correct conditions associated with volvulus and prevent a recurrence. Anterior gastropexy with or without colon displacement is mandatory. Gastric resection may be required for strangulation and necrosis.