{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T09:44:49Z","timestamp":1788515089992,"version":"build-2803163510"},"reference-count":41,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2022,1,21]],"date-time":"2022-01-21T00:00:00Z","timestamp":1642723200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Tomography"],"abstract":"<jats:p>Background: Gastric volvulus (GV) is a life-threatening emergency condition that prompts emergent surgical management. With the advent of high-resolution computed tomography (CT), the role of radiologists in its diagnosis has become essential. Although many cases of GV have been described in the literature, its pathophysiology is still poorly understood. In addition, there is substantial terminological confusion with associated entities such as paraesophageal hernia, upside-down stomach, organo-axial or chronic GV. Methods: We conducted a retrospective review of clinical, radiological findings and other relevant data for seven patients with previous radiological diagnoses of a large hiatus hernia who presented with acute GV to the emergency department of our institution. We report data on age, sex, medical history, clinical presentation, imaging, treatment and outcomes for each case. Results: The CT findings at acute presentation showed the antrum lying above the diaphragm and dilated fundus below the diaphragm. By comparing the position of the stomach at acute presentation with previous imaging examinations, we confirmed a hypothesis put forward by a few authors decades ago that re-herniation of the gastric fundus into the abdomen is a common pathophysiologic trigger leading to acute GV. This hypothesis has not been supported by modern imaging examinations. Conclusions: We have provided imaging evidence supporting that the pathophysiology of many GVs is based on caudal re-descent of hiatal hernia into the abdominal cavity. Given the terminological disparity used in the literature in this context, we believe it appropriate to introduce and extend the term \u2018back-and-forth stomach\u2019 to refer to this type of GV.<\/jats:p>","DOI":"10.3390\/tomography8010019","type":"journal-article","created":{"date-parts":[[2022,1,23]],"date-time":"2022-01-23T20:36:27Z","timestamp":1642970187000},"page":"245-256","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["\u2018Back-and-Forth Stomach\u2019 CT Imaging Findings of a Pathophysiologic Entity Causing Acute Gastric Volvulus"],"prefix":"10.3390","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0663-2856","authenticated-orcid":false,"given":"Antonio Jes\u00fas","family":"L\u00e1inez Ramos-Bossini","sequence":"first","affiliation":[{"name":"Department of Radiology, Virgen de las Nieves University Hospital, 18014 Granada, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eduardo","family":"Ruiz Carazo","sequence":"additional","affiliation":[{"name":"Department of Radiology, Virgen de las Nieves University Hospital, 18014 Granada, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1237-3088","authenticated-orcid":false,"given":"Mar\u00eda Dolores","family":"Rabad\u00e1n Caravaca","sequence":"additional","affiliation":[{"name":"Department of Radiology, Infanta Margarita Hospital, 14940 Cabra, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,1,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"bcr2017223060","DOI":"10.1136\/bcr-2017-223060","article-title":"Second-look laparostomy for perforated gangrenous gastric volvulus to prevent total gastrectomy","volume":"2018","author":"Okeny","year":"2018","journal-title":"BMJ Case Rep."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1016\/j.ijsu.2009.11.002","article-title":"A review article on gastric volvulus: A challenge to diagnosis and management","volume":"8","author":"Rashid","year":"2010","journal-title":"Int. J. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1281","DOI":"10.1148\/rg.295095011","article-title":"Volvulus of the gastrointestinal tract: Appearances at multimodality imaging","volume":"29","author":"Peterson","year":"2009","journal-title":"Radiographics"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"3115","DOI":"10.1007\/s00330-014-3319-2","article-title":"Computed tomography findings of acute gastric volvulus","volume":"24","author":"Millet","year":"2014","journal-title":"Eur. Radiol."},{"key":"ref_5","first-page":"139","article-title":"Singolare attortigliamento dell\u2019esofago col duodeno sequito da rapida morte","volume":"9","author":"Berti","year":"1866","journal-title":"Gazz. Med. Ital."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"103","DOI":"10.2214\/AJR.18.20033","article-title":"CT of gastric volvulus: Interobserver reliability, radiologists\u2019 accuracy, and imaging findings","volume":"212","author":"Mazaheri","year":"2019","journal-title":"Am. J. Roentgenol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"446","DOI":"10.1136\/emj.2006.041947","article-title":"Gastric volvulus","volume":"24","author":"Chau","year":"2007","journal-title":"Emerg. Med. J."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1007\/s10140-019-01669-0","article-title":"Gastric volvulus: Unraveling the diagnosis with MPRs","volume":"26","author":"Verde","year":"2019","journal-title":"Emerg. Radiol."},{"key":"ref_9","first-page":"2961063","article-title":"Acute Gastric Volvulus Causing Splenic Avulsion and Hemoperitoneum","volume":"2018","author":"Cavanagh","year":"2018","journal-title":"Case Rep. Gastrointest. Med."},{"key":"ref_10","first-page":"43","article-title":"Acute obstructive gastric volvulus diagnosed by helical CT","volume":"85","author":"Coulier","year":"2002","journal-title":"JBR-BTR"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"e18","DOI":"10.2349\/biij.5.3.e18","article-title":"Mesenteroaxial volvulus in an adult: Time is of the essence in acute presentation","volume":"5","author":"Singham","year":"2009","journal-title":"Biomed. Imaging Interv. J."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1016\/S0899-7071(02)00549-1","article-title":"Gastric volvulus: Acute and chronic presentation","volume":"27","author":"Shivanand","year":"2003","journal-title":"Clin. Imaging"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"497","DOI":"10.1007\/BF02800929","article-title":"Volvulus des Magens bei Carcinom","volume":"115","year":"1912","journal-title":"Dtsch. Z. Chir."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1148\/34.1.53","article-title":"Chronic gastric volvulus","volume":"34","author":"Singleton","year":"1940","journal-title":"Radiology"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1016\/0002-9610(80)90424-9","article-title":"Acute gastric volvulus. A study of 25 cases","volume":"140","author":"Carter","year":"1980","journal-title":"Am. J. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"557","DOI":"10.1002\/bjs.1800580802","article-title":"Volvulus of the stomach a review with a report of 8 cases","volume":"58","author":"Wastell","year":"1971","journal-title":"Br. J. Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"344","DOI":"10.1016\/j.clinimag.2010.02.001","article-title":"Radiological features of acute gastric volvulus in adult patients","volume":"34","author":"Hani","year":"2010","journal-title":"Clin. Imaging"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"358","DOI":"10.1046\/j.1365-2168.2000.01385.x","article-title":"Changing patterns in the management of gastric volvulus over 14 years","volume":"87","author":"Teague","year":"2000","journal-title":"Br. J. Surg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"366","DOI":"10.1016\/j.ijscr.2017.11.016","article-title":"Acute Organoaxial gastric volvulus: A massive problem with a twist-case report","volume":"41","author":"Daswani","year":"2017","journal-title":"Int. J. Surg. Case Rep."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"505","DOI":"10.1016\/0002-9610(68)90194-3","article-title":"Chronic and recurrent volvulus of the stomach with late results of \u201ccolonic displacement\u201d","volume":"4","author":"Tanner","year":"1968","journal-title":"Am. J. Surg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"933","DOI":"10.1001\/jama.1962.03050370001001","article-title":"Mechanism of Obstruction in Para-Esophageal Diaphragmatic Hernias","volume":"181","author":"Culver","year":"1962","journal-title":"JAMA J. Am. Med. Assoc."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"257","DOI":"10.1148\/119.2.257","article-title":"Intrathoracic stomach: When does it obstruct?","volume":"119","author":"Gerson","year":"1976","journal-title":"Radiology"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1530","DOI":"10.12659\/AJCR.918191","article-title":"Cardiopulmonary impairments caused by a large hiatal hernia with organoaxial gastric volvulus showing upside-down stomach: A case report","volume":"20","author":"Umemura","year":"2019","journal-title":"Am. J. Case Rep."},{"key":"ref_24","first-page":"131","article-title":"Volvulus of the stomach","volume":"103","author":"Dalgaard","year":"1952","journal-title":"Acta Clin. Scand."},{"key":"ref_25","first-page":"61","article-title":"Hiatal hernia with upside-down stomach. Management of acute incarceration: Case presentation and review of literature","volume":"56","author":"Gryglewski","year":"2016","journal-title":"Folia Med. Crac."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Schiergens, T.S., Thomas, M.N., H\u00fcttl, T.P., and Thasler, W.E. (2013). Management of acute upside-down stomach. BMC Surg., 13.","DOI":"10.1186\/1471-2482-13-55"},{"key":"ref_27","first-page":"7428195","article-title":"Laparoscopic Repair of a Large Paraesophageal Hernia with Migration of the Stomach into the Mediastinum Creating an Upside-Down Stomach","volume":"2017","author":"Sakran","year":"2017","journal-title":"Case Rep. Surg."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"784","DOI":"10.1067\/msy.2000.108658","article-title":"Laparoscopic repair of chronic intrathoracic gastric volvulus","volume":"128","author":"Katkhouda","year":"2000","journal-title":"Surgery"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"395","DOI":"10.1016\/j.jviscsurg.2013.07.002","article-title":"Management of large para-esophageal hiatal hernias","volume":"150","author":"Collet","year":"2013","journal-title":"J. Visc. Surg."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"778","DOI":"10.1089\/lap.2016.0332","article-title":"Surgical Treatment of Paraesophageal Hernias: A Review","volume":"26","author":"Andolfi","year":"2016","journal-title":"J. Laparoendosc. Adv. Surg. Technol. A"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"765","DOI":"10.21614\/chirurgia.113.6.765","article-title":"Large Paraesophageal Hiatus Hernia: Is Surgery Mandatory?","volume":"113","author":"Dellaportas","year":"2018","journal-title":"Chirurgia"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1007\/BF01888519","article-title":"Gastric herniation and volvulus: CT and MR appearance","volume":"17","author":"Chiechi","year":"1992","journal-title":"Gastrointest. Radiol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"147","DOI":"10.5230\/jgc.2015.15.2.147","article-title":"Chronic gastric volvulus with laparoscopic gastropexy after endoscopic reduction: A case report","volume":"15","author":"Lee","year":"2015","journal-title":"J. Gastric Cancer"},{"key":"ref_34","first-page":"863","article-title":"Laparoscopic suture gastropexy for gastric volvulus: A report of 14 cases","volume":"21","author":"Palanivelu","year":"2007","journal-title":"Surg. Endosc. Other Interv. Technol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1590\/S0102-67202009000200006","article-title":"Gastric volvulus: A review of 38 cases","volume":"22","author":"Jacob","year":"2009","journal-title":"ABCD Arq. Bras. Cir. Dig."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1186\/1752-1947-2-343","article-title":"Delayed diagnosis of intermittent mesenteroaxial volvulus of the stomach by computed tomography: A case report","volume":"2","author":"Woon","year":"2008","journal-title":"J. Med. Case Rep."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"837","DOI":"10.1016\/S0736-4679(99)00092-X","article-title":"Gastric volvulus: Case report and review of the literature","volume":"17","author":"Godshall","year":"1999","journal-title":"J. Emerg. Med."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"47","DOI":"10.4174\/jkss.2013.85.1.47","article-title":"Acute gastric volvulus treated with laparoscopic reduction and percutaneous endoscopic gastrostomy","volume":"85","author":"Jeong","year":"2013","journal-title":"J. Korean Surg. Soc."},{"key":"ref_39","first-page":"407","article-title":"Complications related to percutaneous endoscopic gastrostomy (PEG) tubes. A comprehensive clinical review","volume":"16","author":"Schrag","year":"2007","journal-title":"J. Gastrointest. Liver Dis."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"389","DOI":"10.1097\/00129689-200312000-00009","article-title":"Emergent Laparoscopic Reduction of Acute Gastric Volvulus with Anterior Gastropexy","volume":"13","author":"Naim","year":"2003","journal-title":"Surg. Laparosc. Endosc. Percutaneous Technol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"136381","DOI":"10.1155\/2014\/136381","article-title":"Successful gastric volvulus reduction and gastropexy using a dual endoscope technique","volume":"2014","author":"Jamil","year":"2014","journal-title":"Case Rep. Med."}],"container-title":["Tomography"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2379-139X\/8\/1\/19\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T22:05:37Z","timestamp":1760133937000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2379-139X\/8\/1\/19"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,1,21]]},"references-count":41,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2022,2]]}},"alternative-id":["tomography8010019"],"URL":"https:\/\/doi.org\/10.3390\/tomography8010019","relation":{},"ISSN":["2379-139X"],"issn-type":[{"value":"2379-139X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,1,21]]}}}