A twisted stomach, medically known as gastric volvulus, is a rare but serious condition where the stomach abnormally rotates on itself. This twisting can obstruct the flow of food and fluids, potentially cutting off the stomach’s blood supply. When this occurs, it can lead to severe complications such as tissue death, making immediate medical attention necessary. Gastric volvulus can manifest suddenly as an acute emergency or present as a chronic, intermittent issue.
Understanding Gastric Volvulus
Gastric volvulus involves the stomach twisting by more than 180 degrees. This rotation can lead to a closed-loop obstruction. The twisting can happen in two main ways: organoaxial or mesenteroaxial. In organoaxial volvulus, the stomach rotates around its long axis, and the greater curvature of the stomach typically lies above the lesser curvature. This type is the most common, accounting for about two-thirds of cases.
Mesenteroaxial volvulus occurs when the stomach twists around an axis perpendicular to its long axis, often involving the lesser and greater curvatures. While less common, this type is more frequently associated with reduced blood flow to the stomach tissue. A combined type, where both forms of twisting occur, is rare and typically seen in chronic cases.
Recognizing the Symptoms
Symptoms of a twisted stomach often appear suddenly and are intense. A classic set of symptoms, known as Borchardt’s Triad, includes severe upper abdominal pain, retching without vomiting, and the inability to pass a tube into the stomach. This triad is present in up to 70% of acute organoaxial volvulus cases.
Patients may also experience significant bloating, nausea, and a feeling of fullness. The pain can be localized to the upper abdomen or left upper quadrant, and in some instances, it might radiate to the left shoulder, neck, or back. In severe cases, particularly if the stomach’s blood supply is compromised, symptoms can progress to signs of shock, such as rapid heart rate and low blood pressure. If the condition is chronic, symptoms may be intermittent and less severe, including vague upper abdominal pain, early satiety, and hiccups.
Common Causes and Risk Factors
Gastric volvulus can result from both congenital factors and acquired conditions. Congenital factors include abnormal development or laxity of the ligaments that normally hold the stomach in place. Diaphragmatic defects, such as hiatal hernias where part of the stomach protrudes into the chest cavity, are a common acquired cause, accounting for about one-third of cases and being the most frequent cause in both children and adults.
Other acquired factors can include previous abdominal surgery, trauma, or certain medical conditions that affect stomach function or mobility. Conditions like asplenism, issues with small and large bowel development, or pyloric stenosis have also been associated with gastric volvulus. While it can occur at any age, gastric volvulus is observed more frequently in infants younger than one year and in older adults, typically those over 50 years old.
Diagnosis and Treatment Options
Diagnosing gastric volvulus often begins with a thorough physical examination. Imaging tests are essential to confirm the diagnosis. Plain X-rays of the chest or abdomen may show a distended stomach or a double air-fluid level. Computed tomography (CT) scans are frequently used and can provide an immediate diagnosis by showing the stomach’s rotation and any associated issues like a hiatal hernia or compromised blood supply.
Barium studies, where a contrast liquid is swallowed, are also sensitive and specific for diagnosing gastric volvulus, often revealing an upside-down stomach. Endoscopy, which involves inserting a flexible tube with a camera down the throat, can help visualize the stomach’s anatomy and identify any obstruction.
Treatment for acute gastric volvulus is almost always an emergency surgical procedure. The primary goals of surgery are to untwist the stomach and to prevent it from twisting again. To prevent recurrence, a procedure called gastropexy is commonly performed, which involves surgically attaching the stomach to the abdominal wall or diaphragm. This can be done using sutures or by placing a gastrostomy tube.
In cases where the stomach tissue has been damaged due to lack of blood flow, a portion of the stomach may need to be removed. While open surgery is traditional, minimally invasive laparoscopic approaches are increasingly used.
Recovery and Prognosis
After surgical intervention for gastric volvulus, recovery involves a period of healing and careful monitoring. Initial management often includes intravenous fluids and gastric decompression using a nasogastric tube to relieve pressure. The length of hospital stay can vary, but studies have reported a median hospitalization of around 8 days.
The prognosis after successful surgical treatment is generally favorable. Potential complications can arise, including infection, bleeding, or continued issues with stomach function. The gastropexy procedure aims to significantly reduce the chance of the stomach twisting again. Long-term follow-up with medical professionals is important to monitor recovery and address any lingering symptoms or concerns.