The condition known colloquially as “twisted stomach” is formally called Gastric Volvulus (GV). This rare but extremely dangerous medical event occurs when the entire stomach or a portion of it twists abnormally on itself by at least 180 degrees. This rotation causes a complete blockage of the digestive tract and severely compromises the blood supply to the stomach tissue. Because of the risk of tissue death and potential perforation, acute Gastric Volvulus requires immediate emergency medical attention.
Defining Gastric Volvulus and Its Types
Gastric Volvulus is classified into two primary types based on the rotational axis around which the stomach twists. The first, and most common type, is Organoaxial Volvulus, accounting for approximately 60% of cases. In this variant, the stomach rotates around its long axis, running from the esophagus connection (cardia) to the small intestine exit (pylorus). This rotation often results in a rapid and complete obstruction, effectively sealing both the entrance and exit of the stomach.
The second type is Mesenteroaxial Volvulus, where the stomach rotates around its short axis, perpendicular to the long axis, connecting the lesser and greater curvatures. While less common, this type is associated with a higher risk of compromising the blood vessels that supply the stomach. Both types of rotation create a closed loop where gas and fluid become trapped, leading to rapid distention and painful pressure on surrounding organs.
Recognizing the Signs of an Emergency
The clinical presentation of acute Gastric Volvulus often includes a classic set of symptoms, known as Borchardt’s Triad, which occurs in up to 70% of acute cases. The first sign is the sudden onset of severe pain, concentrated in the upper abdomen or epigastric region. This intense pain is followed by intractable dry retching, which is the urge to vomit without expelling contents.
The third sign is the inability to pass a nasogastric tube into the stomach, indicating a mechanical obstruction at the stomach’s entrance. These three signs demand immediate medical attention. The upper abdomen may also show progressive distention as the stomach rapidly fills with trapped air and fluid. Delays in seeking care increase the risk of the stomach tissue losing its blood supply, which raises the mortality rate.
Factors That Increase Risk
The stability of the stomach normally depends on four key ligaments that anchor it to other abdominal structures, including the gastrosplenic and gastrocolic ligaments. A primary (idiopathic) Gastric Volvulus occurs when these suspensory ligaments are abnormally lax or absent, allowing the stomach too much freedom of movement. This congenital laxity accounts for up to two-thirds of all cases and makes the stomach vulnerable to twisting, particularly when full.
In other cases, the volvulus is secondary to an anatomical defect that displaces the stomach from its normal position. The most common acquired predisposing factor is a large paraesophageal hernia, where a portion of the stomach protrudes into the chest cavity through an opening in the diaphragm. Previous abdominal surgery or trauma can also destabilize the stomach by altering its surrounding anatomy or creating internal adhesions that act as a fixed point for rotation. Conditions causing paralysis of the diaphragm can also increase the risk by allowing the stomach to shift abnormally.
Emergency Medical Intervention
The initial steps in managing acute Gastric Volvulus focus on rapid diagnosis and stabilization before definitive treatment. Diagnostic imaging, such as a computed tomography (CT) scan or an X-ray, is used to confirm the abnormal rotation and identify the characteristic features of the twisted stomach. An X-ray might reveal a massively distended stomach with two distinct air-fluid levels or a spherical shape. The CT scan provides a detailed view of the rotational axis.
Emergency surgical intervention is required to correct the life-threatening obstruction. The procedure involves untwisting the stomach, a process known as detorsion. Once the stomach is returned to its normal position, the surgeon assesses the tissue for viability; if necessary, a portion of the stomach may need to be removed. The final step is a gastropexy, a procedure where the stomach is permanently fixed to the abdominal wall to prevent recurrence. This surgery is often performed using minimally invasive laparoscopic techniques, though open surgery may be necessary in complex cases.