A twisted stomach, medically known as Gastric Volvulus, is a life-threatening condition defined by the abnormal rotation of the stomach by more than 180 degrees. This rotation immediately creates a closed-loop obstruction, sealing off both the stomach’s entry and exit points. Acute gastric volvulus is a surgical emergency that can lead to severe complications and death if not identified and treated rapidly.
How the Stomach Physically Twists
The process begins with Gastric Dilatation, where the stomach fills with gas, fluid, or food and becomes severely distended. This distension often precedes the rotation, or volvulus, as a heavy, mobile stomach is more prone to twisting on its axis. The rotation typically occurs around the line connecting the stomach’s entrance (esophagogastric junction) and its exit (pylorus), a mechanism called organoaxial volvulus.
Once the stomach twists by more than 180 degrees, the two main openings are obstructed, trapping contents inside. This obstruction prevents the release of accumulated gas and fluid, causing pressure buildup within the stomach wall. Simultaneously, the rotation often pinches the blood vessels supplying the stomach and sometimes the spleen, leading to restricted blood supply.
The restricted blood flow deprives the stomach tissue of oxygen, resulting in tissue death, or necrosis, and potentially perforation. This tissue damage rapidly releases toxins into the bloodstream, triggering severe systemic shock as circulation fails. The mortality rate for acute gastric volvulus can be high, historically ranging from 30% to 50%, underscoring the severity of the vascular compromise.
Identifying the Warning Signs
Recognizing the onset of acute gastric volvulus is important because symptoms progress quickly, often within hours. The most classic presentation is known as Borchardt’s triad, which occurs in about 70% of acute cases. The triad includes sudden, severe upper abdominal pain, non-productive retching, and the inability to pass a tube into the stomach.
The severe abdominal pain is often constant and felt in the upper abdomen. Non-productive retching, or dry heaving, is a distinguishing feature where the individual tries intensely to vomit but produces nothing or only small amounts of white froth. This happens because the twist has sealed off the stomach’s exit.
Physical signs include a visibly distended abdomen that can feel hard or tight due to the trapped gas. As the condition progresses, signs of circulatory shock appear, such as rapid breathing, a weak pulse, and pale mucous membranes. Any presentation involving these symptoms requires immediate transport to an emergency department for evaluation.
Emergency Medical Procedures
Immediate management involves two concurrent phases: stabilization and surgical correction. The first step is patient stabilization, focusing on managing shock and internal pressure. Medical teams quickly initiate intravenous fluid resuscitation to correct low blood pressure and restore circulating volume.
Decompression of the severely distended stomach is attempted rapidly to relieve pressure on surrounding blood vessels and organs. This is typically done by attempting to pass a nasogastric tube into the stomach, though this can be difficult if the twist is complete. If a tube cannot be passed, a needle or catheter may be used to temporarily relieve gas pressure.
Definitive treatment is emergency surgery, known as detorsion, to manually untwist the stomach. During the procedure, the surgeon assesses the stomach wall for tissue death. Any non-viable, necrotic tissue must be removed, which may involve partial removal of the stomach. To prevent recurrence, the stomach is then surgically secured to the abdominal wall in a procedure called gastropexy.
Minimizing Future Risk
For individuals who have experienced acute gastric volvulus, or those identified as high-risk due to predisposing anatomical factors like a large hiatal hernia, preventative measures are recommended. The primary goal of long-term management is to prevent the stomach from having the mobility required to twist again.
Surgical fixation of the stomach, or gastropexy, is the most effective preventative measure against recurrence. This procedure anchors the stomach to the abdominal wall, significantly limiting its movement and the possibility of future rotation. Gastropexy can be performed laparoscopically, which is a less invasive surgical approach.
Lifestyle modifications also play a supportive role in reducing risk. This includes avoiding the consumption of very large meals, which can overfill and weigh down the stomach. It is also advisable to limit vigorous physical activity immediately following a meal, as increased movement may contribute to gastric instability.