Gastric volvulus is a condition in which the stomach twists around its longitudinal or transverse axis, preventing food from entering the stomach after it has been absorbed through the esophagus. In most cases, the twisting is a complication of fundoplication. Acute volvulus can be treated only by surgical repositioning.
What is gastric volvulus?
Gastric volvulus is a broad group of diseases. Sit contains both the actual primary diseases of the stomach, as well as their complications. Gastric volvulus is one such complication. By the term volvulus, medicine refers to a pathological and abnormal twisting. In patients of gastric volvulus, the organ twists spirally around the longitudinal axis. Transverse axis twisting is also referred to as gastric volvulus. Physicians distinguish acute gastric volvulus from a chronic form. The acute form manifests in infancy and is associated with an extremely low prevalence. In both forms, the twisting predominantly affects the portion of the stomach located above the diaphragm. Twisting of the stomach does not usually occur naturally or in the setting of a specific primary disease, but is interpreted primarily as a complication of medical intervention. When primary diseases frame the gastric twisting, the phenomenon may also be referred to as symptomatic.
Causes
In most cases, gastric torsion is associated with a previous fundoplication. This treatment is equivalent to surgery for therapy of reflux esophagitis. This condition is a form of reflux disease that manifests primarily in heartburn. Fundoplication is performed open-surgically or laparoscopically for the treatment of this disease. Portions of the gastric fundus are loosely wrapped around the esophagus during this procedure. The wrapping is done at the lower esophageal sphincter. A suture is used for fixation. The resulting pressure provides additional support to the sphincter and makes it close all the better when the stomach is filled. In reflux disease, the reflux of the stomach contents is prevented in this way. When the stomach wraps around the esophagus, acute gastric volvulus may occur. However, the phenomenon is considered a rare complication. Acute gastric volvulus in infants should be distinguished from it. Gastric volvulus may also occur in hiatal hernia. This phenomenon corresponds to the pathological passage of parts of the stomach through the diaphragm. In addition, gastric volvuli may occur as a result of relaxation of the diaphragm. Less frequently, they occur in the case of positional changes due to gastric or neighboring organ diseases. In some cases, overinflation of the intestine triggers intermittent gastric torsion.
Symptoms, complaints, and signs
Acute volvulus manifests clinically in somewhat different symptoms than chronic volvulus. In patients with acute complete gastric volvulus, the stomach is incapable of either upward or downward movement. The organ is therefore unable to empty. The patients thus suffer from symptomatic ileus. The stomach becomes increasingly distended and passage through the esophagus is no longer possible when food is ingested. Food no longer reaches the stomach. Nausea, vomiting and loss of appetite characterize the phenomenon. In the course, necrosis of the stomach wall may develop. Perforation or air embolism of the portal circulation are also conceivable late symptoms. In chronic volvulus, there is incomplete twisting of the stomach. The obstruction of the passage is thus not so pronounced. The clinical symptoms are also less pronounced than in the acute form. Often, chronic volvulus even manifests so little in symptoms that a diagnosis is not made until late.
Diagnosis and course of the disease
The diagnosis of gastric volvulus is made by imaging after taking an appropriate history. Sonography shows the pylorus in an abnormal position. Radiographic imaging is performed in the standing or hanging position and demonstrates air filling of the stomach. Imaging with contrast administration confirms stoppage of passage. In complete obstruction with epigastric meteorism, there is no simple gastric volvulus but a Borchardt triad.
Complications
Gastric volvulus is a very serious complaint and must be treated by a physician in all cases.If this is not treated, the patient will eventually die. Usually, the stomach can no longer empty due to the twisting, which can lead to severe pain and eventually intestinal obstruction. This complication can be fatal if treated promptly. The affected person suffers from vomiting and nausea due to the gastric volvulus, furthermore the patient also suffers from loss of appetite. Not infrequently, breathing difficulties also occur and the affected person feels unwell. The patient suffers from fatigue and exhaustion, and a general feeling of illness sets in. Diagnosis of gastric volvulus is relatively quick and easy, so that early treatment can be initiated. Complications usually do not occur if treatment is given early enough. If treatment is delayed, necrosis may form on the stomach wall. However, the stomach can usually be returned to its usual position through the procedure, so there is no further discomfort. The patient’s life expectancy is also not affected by this disease if early treatment occurs.
When should one go to the doctor?
If symptoms such as nausea, vomiting or dizziness occur, a visit to the doctor should be made. If the irregularities persist for several days or increase in intensity, it is advisable to see a doctor to clarify the cause. If there is a loss of weight, loss of appetite or a general feeling of illness, a doctor should be consulted. Disturbances of the digestive tract, an intestinal obstruction as well as a diffuse feeling of pain indicate a health impairment. A visit to the doctor is advisable to avoid further problems. Consultation with a physician is always required before taking a pain medication. Otherwise, complications may arise that result in further deterioration of health. If there are inconsistencies in going to the toilet, the indications should be discussed with a doctor. If there are sleep disturbances, an inner restlessness or a sensitivity to pressure, a doctor is needed. If the affected person suffers from irritability, swellings appear on the body or behavioral abnormalities are noticed, a doctor should be consulted. A visit to the doctor is advisable as soon as disturbances in breathing occur. In case of shortness of breath, difficulty in breathing or anxiety, medical examinations should be initiated. If the daily requirements can no longer be met or if a decrease in the usual physical activities sets in, a visit to the doctor is necessary.
Treatment and therapy
If complete gastric torsion is present, a feeding tube cannot be placed for treatment. Conservative treatment options are equally unlikely to be successful. Gastric torsion is treated causally rather than symptomatically. The aim of treatment is thus to restore the physiological position of the stomach. After this repositioning, all accompanying symptoms recede. Ideally, treatment is performed well before complications such as necrosis of the stomach walls develop. The way to reposition the stomach is surgical in almost all cases. During the procedure, the doctor moves the stomach to a neutral position and fixes it so that it cannot move again. Acute volvulus cannot be treated in endoscopic or percutaneous procedures. Intermittent volvulus of the stomach may be treated microsurgically. If necrosis of the stomach walls has already occurred, the dead portions of the stomach may need to be removed and replaced. If the twisting of the stomach has occurred in the setting of a specific primary disease, the causes of the primary disease must be corrected to rule out recurrences of gastric volvulus.
Outlook and prognosis
If left untreated, gastric volvulus can result in a life-threatening condition. In addition to severe pain, intestinal obstruction gradually occurs. This threatens the affected person with premature death. However, with early diagnosis as well as medical treatment, the prognosis is favorable. The sooner health care is provided, the better are the possibilities of therapy. It comes to the use of conservative treatment methods, which lead to relief of symptoms. As a result, gastric torsion is temporarily cured.Nevertheless, in order not to develop a recurrence of the irregularities, the cause of the disease must be found and eliminated. The twisting of the stomach is not an independent disease, but a symptom of an existing primary disease. If this is not treated, the symptoms can be expected to return at any time. In most cases, the primary disease can be completely cured by surgery. Although this is associated with the usual risks and side effects, it is nevertheless a routine procedure that is usually trouble-free. After the wound has healed, the patient should see a doctor regularly for check-ups. This additionally improves the prognosis and prevents further complications. A recurrence of gastric volvulus can basically be almost ruled out if the primary disease has been completely healed.
Prevention
The twisting of the stomach inform of gastric volvulus can be prevented to a small extent. In most cases, it is a complication of fundoplication. When experienced surgeons perform fundoplication in specially designed centers, gastric volvulus as a complication of surgery is almost eliminated. Thus, the mindful selection of the surgeon should be understood as a preventive measure in the broadest sense.
Aftercare
If gastric volvulus disease is diagnosed early, it can usually be treated in a timely and uncomplicated manner. With early treatment, complications usually do not occur. Delayed treatment of gastric volvulus can cause necrosis to form on the stomach wall. In most cases, however, the stomach can be restored to normal by surgical removal. No further symptoms then occur. Follow-up care therefore focuses on the positive healing process, which is monitored by an attending physician. As long as this is not fully completed, those affected have to adapt their everyday life to the disease, and sometimes they need help from relatives and friends. In addition, care should be taken to eat food that is gentle on the stomach so as not to further irritate the damaged stomach wall. Sufficient exercise and a gentle mode contribute to recovery.
This is what you can do yourself
Patients with gastric volvulus should refrain from eating lavish meals. Small meals taken several times throughout the day will improve the general health condition and relieve the symptoms. In addition, it is advisable if the food is easily digestible and rich in vitamins. The consumption of harmful or toxic substances should be avoided in everyday life. The consumption of alcohol or nicotine has a harmful effect on the organism and thus on the digestive tract. As soon as a feeling of indisposition occurs, further food intake should be paused and continued at a later time. At the same time, care must be taken to avoid underfeeding, otherwise a life-threatening condition will be triggered. If the patient suffers from a loss of appetite, he should learn to overcome himself in order to ensure a sufficient supply of food. It is helpful to have the support of relatives and friends, with whom food can be taken in regularly. If, despite all efforts, the patient loses a lot of weight, it is necessary to consult a doctor. There is a risk of an undersupply of the body, which will trigger further complications. Overexertion and physical strain should be avoided. Sufficient exercise improves well-being, but it should be oriented to the needs of the patient.
