In gastric volvulus, the stomach twists about the longitudinal or transverse axis so that food can no longer enter the stomach after it has been absorbed through the esophagus. Torsion is usually a complication of a fundoplication. Acute volvulus can only be treated by surgical repositioning.
What is gastric volvulus?
According to Psyknowhow, the group of gastric diseases is a wide-ranging group of diseases. Sit contains both the actual primary diseases of the stomach and their complications. Gastric volvulus is one such complication. By the term volvulus, medicine refers to a pathological and abnormal twisting. In patients with gastric volvulus, the organ twists like a spiral around the longitudinal axis.
Transverse twists are also referred to as gastric volvulus. The doctor distinguishes an 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 primarily affects the part of the stomach that lies above the diaphragm.
Torsion of the stomach does not usually occur naturally or as part of a specific primary disease, but is mainly interpreted as a complication of medical intervention. If primary diseases set the framework for gastric torsion, the phenomenon can also be considered a symptomatic phenomenon.
Causes
Torsion of the stomach is usually associated with a previous fundoplication. This treatment corresponds to an operation to treat reflux oesophagitis. This disease is a form of reflux disease, which is particularly noticeable in heartburn. Fundoplication is performed open surgically or laparoscopically to treat this condition. In this procedure, parts of the gastric fundus are loosely wrapped around the esophagus.
The winding is done on the lower esophageal sphincter. A suture is used for fixation. The resulting pressure gives the sphincter additional support and closes all the better when the stomach is full. In the case of acid reflux disease, the backflow of the stomach contents is prevented in this way. Acute gastric volvulus can occur when the stomach wraps around the esophagus. However, the phenomenon is considered a rare complication.
This is to be distinguished from acute gastric volvuli in infants. Gastric volvuli can also occur with a hiatal hernia. This phenomenon corresponds to the pathological passage of parts of the stomach through the diaphragm. In addition, gastric volvuli can occur as a result of relaxation of the diaphragm. Rarely, they occur with changes in position due to diseases of the stomach or neighboring organs. In some cases, intestinal overinflation triggers intermittent gastric torsion.
Symptoms, Ailments & Signs
Clinically, acute volvulus presents with somewhat different symptoms than chronic volvulus. In patients with acute complete gastric volvulus, the stomach is unable to move either up or down. The organ can therefore no longer empty itself. The patients suffer from a symptomatic ileus.
The stomach becomes increasingly bloated and it is no longer possible to pass through the esophagus when eating. Food no longer reaches the stomach. Nausea, vomiting and loss of appetite characterize the phenomenon. Necrosis of the gastric wall can develop over time.
A perforation or an air embolism of the portal circulation are also conceivable late symptoms. Chronic volvulus is an incomplete torsion of the stomach. The hindrance of the passage is not so pronounced. The clinical symptoms are also less pronounced than in the acute form. Chronic volvuli often show so few symptoms that a diagnosis is only made at a late stage.
Diagnosis & course of disease
Diagnosis of gastric volvulus is based on imaging, based on anamnesis. Sonography shows the pylorus in an abnormal position. X -ray imaging is done standing or hanging and shows an air filling of the stomach. Imaging with the administration of contrast medium confirms that the passage has been stopped. Complete occlusion with epigastric meteorism is not a simple gastric volvulus, but a Borchardt triad.
Complications
Gastric volvulus is a very serious condition and must be treated by a doctor. If left untreated, the patient will eventually die. As a rule, the stomach can no longer empty due to the twisting, which can lead to severe pain and ultimately to an intestinal obstruction. This complication can be fatal if treated promptly.
Those affected suffer from vomiting and nausea due to gastric volvulus, and the patient also has a loss of appetite. Not infrequently, breathing difficulties also occur and those affected feel unwell. The patient becomes tired and exhausted and a general feeling of illness occurs. Diagnosis of gastric volvulus is relatively quick and easy, allowing early treatment to be initiated.
Complications usually do not occur if treatment is given early enough. If the treatment is delayed, necrosis can form on the stomach wall. As a rule, however, the stomach can be brought back into its usual position through the procedure, so that there are no further complaints. Also, the life expectancy of the patient is not affected by this disease if it comes to early treatment.
When should you go to the doctor?
If symptoms such as nausea, vomiting or dizziness occur, a doctor should be consulted. If the irregularities last for several days or if they increase in intensity, it is advisable to consult a doctor to clarify the cause. Consult a doctor if you lose weight, lose your appetite or feel generally ill. Disorders of the digestive tract, an intestinal obstruction and a diffuse sensation of pain indicate a health impairment.
A doctor’s visit is advisable to avoid further problems. Before taking any pain medication, it is always necessary to consult a doctor. Otherwise, complications may arise that result in further deterioration of health. If there are any discrepancies when going to the toilet, the instructions should be discussed with a doctor.
In the case of sleep disorders, inner restlessness or sensitivity to pressure, a doctor is required. If the person concerned suffers from irritability, swelling occurs on the body or behavioral problems are noticed, a doctor should be consulted. A doctor’s visit is advisable as soon as breathing disorders occur. In the event of shortness of breath, difficult breathing or a feeling of anxiety, medical examinations must be initiated. If the daily requirements can no longer be met or if there is a decrease in the usual physical activities, a doctor’s visit is necessary.
Treatment & Therapy
If there is complete gastric torsion, a nasogastric tube cannot be placed for treatment. Conservative therapy options also promise little success. The gastric torsion is not treated symptomatically, but causally. The aim of the treatment is therefore to restore the physiological position of the stomach. After this repositioning, all accompanying symptoms disappear.
Ideally, treatment should take place well before complications such as necrosis of the stomach walls develop. The route to repositioning the stomach is surgical in almost all cases. During the procedure, the doctor moves the stomach into a neutral position and fixes it so that it cannot slip again. Acute volvulus cannot be treated by endoscopic or percutaneous procedures.
Intermittent gastric volvuli may be treated microsurgically. If necrosis of the stomach walls has already occurred, the dead parts of the stomach may need to be removed and replaced. If the torsion of the stomach occurred in the context of a specific primary disease, the causes of the primary disease must be corrected to rule out recurrence of gastric volvulus.
Outlook & Forecast
If left untreated, gastric volvulus can become a life-threatening condition. In addition to severe pain, there is gradually an intestinal obstruction. This threatens the victim with premature death. However, with early diagnosis and medical treatment, the prognosis is favorable. The sooner health care is provided, the better the options for therapy. Conservative treatment methods are used to alleviate the symptoms. This temporarily cures the torsion of the stomach.
However, to ensure that the irregularities do not recur, the cause of the disease must be found and eliminated. Twisting of the stomach is not an independent disease, but a symptom of an existing primary disease. If this is not treated, the complaints can be expected to return at any time. In most cases, the underlying disease can be completely cured with surgery. Although this is associated with the usual risks and side effects, it is still a routine process that usually runs smoothly.
After the wound has healed, the affected person should see a doctor regularly for check-ups. This further improves the prognosis and prevents further complications. A recurrence of gastric volvulus can basically be ruled out if the primary disease has been completely cured.
Prevention
Torsion of the stomach in the form of gastric volvulus can be prevented to a small extent. In most cases it is a complication of fundoplications. If experienced surgeons perform the fundoplication in specially designed centers, gastric volvulus as a complication of the operation is almost impossible. The careful selection of the surgeon is therefore to be understood as a preventive measure in the broadest sense.
Aftercare
If gastric volvulus is diagnosed early, it can usually be treated promptly and easily. With early treatment, there are usually no complications. Delayed treatment of gastric volvulus can result in necrosis of the gastric wall. In most cases, however, the stomach can be brought back to its normal state by surgical removal. There will then be no further complaints. The aftercare therefore focuses on the positive healing process, which is monitored by the treating doctor. As long as this is not completely over, those affected have to adapt their everyday life to the disease, sometimes they need help from relatives and friends. In addition, care should be taken to eat a diet that is gentle on the stomach so as not to further irritate the damaged stomach wall.
You can do that yourself
Patients with gastric volvulus should refrain from eating heavy meals. Small meals, eaten several times throughout the day, improve general health and alleviate symptoms. It is also advisable if the food is easily digestible and rich in vitamins. The consumption of pollutants or toxins 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.
If discomfort occurs, stop feeding and continue at a later time. At the same time, care must be taken to ensure that there is no undersupply, 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 an adequate intake of food. It is helpful to have the support of relatives and friends with whom you can regularly eat together.
If, despite all your efforts, you lose a lot of weight, you need to consult a doctor. There is a risk of an undersupply of the body, which triggers further complications. Overexertion and physical stress should be avoided. Sufficient exercise improves well-being, but this should be based on the needs of the patient.
