This type is more common in children. The classic clinical triad is violent retching without vomitus, severe epigastric pain and difficulty passing an NG tube past the distal esophagus. Gastric outlet obstruction and vascular compromise can occur. Rapid clinical diagnosis is key, gastric volvulus is a surgical emergency. A double air fluid level is seen in the upright position, one in the fundus, which is inferior, one in the antrum, which is superior.
Organoaxial volvulus is more subtle.
The inferiorly displaced GE junction may serve as a subtle diagnostic sign. Scott RL, Selker R, Rimer-Muram H, et al. A Sign of Intrathoracic Gastric Volvulus. Embryology for Surgeons, 2nd Ed.