What Is Gastric Volvulus?

Gastric torsion is a disorder of the fixation mechanism of the normal position of the stomach or its adjacent organs, which causes gastric displacement, causing the stomach itself to undergo abnormal gastric torsion along different axes, causing morphological changes. Gastric torsion is uncommon, its acute type develops rapidly, it is not easy to diagnose, and treatment is often delayed; its chronic type is atypical, and it is not easy to find in time.

Basic Information

English name: volvulus of stomach
Visiting department: Basic surgery
Common locations: stomach

Common causes: Congenital malformations, anatomical factors
Common symptoms: Sudden and sudden chest or epigastric pain, persistent retching, little or no vomiting, etc.

Causes of gastric torsion

Congenital malformation

Neonatal gastric torsion is a congenital malformation that may be related to malrotation of the small intestine, causing the spleen-gastric ligament or gastrocolonic ligament to relax and cause poor gastric fixation. Most can correct themselves as the baby grows and develops.

2. Anatomical factors

Most gastric torsion in adults has anatomical factors, which are caused by different incentives. The normal position of the stomach mainly depends on the fixation of the lower end of the esophagus and the pylorus. Hepatogastric ligaments, gastrocolonic ligaments, and spleen-gastric ligaments also play a role in fixing the large and small curvatures of the stomach. Large esophageal hiatal hernias, septal hernias, septal bulges, and excessive peritoneal relaxation of the lower part of the duodenum make the lower end of the esophagus and the pylorus at the esophageal hiatus difficult to fix. In addition, sagging stomachs, large or small ligaments, or loose or excessively long ligaments, are anatomical factors for the onset of gastric torsion.

3. Other

Acute gastric distension, acute flatulence, overeating, severe vomiting, and reverse peristalsis of the stomach can become the driving force for sudden changes in the position of the stomach, and are therefore often the inducement of acute gastric torsion. Inflammation and adhesion around the stomach can cause the stomach wall to be fixed in an abnormal position and twist. These lesions are often the cause of chronic gastric twist.

Gastric torsion clinical manifestations

The acute onset of gastric torsion is sudden and develops rapidly, and its clinical manifestations are pain in the upper abdomen (subcondylar type) or left chest (supercondylar type). Patients with sub-patellar gastric torsion significantly swell the upper abdomen while the lower abdomen remains flat and soft; whereas patients with sub-patellar gastric torsion experience chest symptoms while the upper abdomen can be normal. Chest pain can radiate to the arms and neck and is accompanied by dyspnea, so it is often misdiagnosed as myocardial infarction. Patients often have persistent retching with little vomit, and rarely vomiting blood. If vomiting, it usually indicates mucosal ischemia or esophageal laceration. Typical triad:

1. Sudden and severe chest or epigastric pain.

2. Persistent retching with little or no vomit.

3. It is difficult to insert the gastric tube in the stomach; if the twist is light, the clinical manifestation is very atypical.

Chronic gastric torsion is mostly partial in nature, without obstruction, and without obvious symptoms, or its symptoms are mild, similar to chronic diseases such as ulcers or chronic cholecystitis.

Gastric twist test

Laboratory inspection

When complications occur (hemorrhage of the upper gastrointestinal tract), a routine blood test may show a decrease in hemoglobin.

2. Imaging examination

(1) X-ray barium meal X-ray examination is the preferred method for the diagnosis of gastric torsion. The X-ray of the organ axis-shaped gastric torsion is as follows: The position of the gastric curvature of the stomach body and antrum is elevated, which causes the gastric curvature to turn upwards and the gastric curvature to turn downwards, forming a convex shape with the convex side facing upward and the concave side facing downward. It looks like a shrimp; the lower part of the esophagus is prolonged; the esophagus and the gastric mucosa fold together, and the gastric mucosa is spiral; double gastric bubbles and double liquid-gas planes are visible in the stomach. Omental axis gastric torsion manifests as follows: the gastric antrum is turned to the left and raised, causing the stomach to bend to the right and the stomach to the left; the gastric mucosa is crisscross and the entire stomach is "curvature. Mixed Gastric torsion has the characteristics of the above two types.

(2) Endoscopy has some difficulties when the stomach is twisted. Endothelial lines and gastric mucosal folds are distorted. Changes in the anatomical position of the gastric cavity, such as large and small curvatures, inverted front and back walls, displacement of the pylorus, and enlarged gastric cavity Cone stenosis has resistance when entering the mirror, and some patients may find esophagitis, tumors or ulcers.

Gastric Torsion Diagnosis

Diagnosis can be made based on the above symptoms, signs, and imaging findings.

Differential diagnosis of gastric torsion

1. High intestinal torsion

This disease is most likely to be confused with gastric torsion, but the vomiting of high intestinal obstruction is sharper, more frequent, and more abundant, and contains bile than gastric torsion. At the same time, abdominal pain caused by small intestinal torsion is more severe than gastric torsion, and it is persistent. Hyperphonic tone, abdominal X-ray performance is also different, can be identified.

2. Acute gastric distension

This disease is mainly caused by abdominal distension and pain, and the abdominal pain is not serious. Nausea and frequent weak vomiting; vomit contains bile in large quantities. The gastric tube is easy to insert and can extract a large amount of liquid and gas. The patient had dehydration and metabolic alkalosis, with early onset of shock.

3. Acute gastritis

This disease has sudden epigastric pain, accompanied by vomiting, which is easy to be confused with acute gastric torsion. Therefore, attention should be paid to the identification. The main points are as follows: Vomiting is more frequent than acute gastric torsion. The gastric torsion does not contain bile; the disease can be inserted into the gastric tube, and the complete gastric cardia can not be inserted into the gastric tube; X-ray examination of the gastric torsion can find two gastric bubbles, but acute gastritis has no signs of this.

4. Waterfall-like stomach

There is obvious gastric motility disorder, which can be manifested as gastric fundus, enlarged body cavity, and retaining a large amount of fluid. The organ axis-type gastric torsion should be distinguished from the waterfall-shaped stomach, and the similarity of barium to stagnate in the gastric vesicle to form a sac. Judging whether the positions of the large and small curvatures of the stomach are upside down, whether the opening of the esophagus and cardia is located below the stomach and whether two liquid levels appear in the upright stomach are of great significance for the differential diagnosis of the two.

5. Gastrointestinal changes caused by extra gastrointestinal masses

For example, when the spleen cyst, pancreatic tail cyst and other lesions, the stomach is pushed up and shifted inward to the right, so that the shape of the stomach changes. At this time, attention should be paid to the position of the small curvature of the stomach or the relationship between the esophagus and the gastric mucosa.

Gastric torsion complications

Stomach torsion can be caused by blood circulation disorders of the stomach wall, causing necrosis, ulcers and perforations, causing water and electrolyte disturbances, and esophagitis.

Gastric torsion treatment

Conservative treatment

(1) Manipulative reduction Standing forward leaning rehabilitation The patient takes 300-500ml of barium orally and leans forward. The patient stands behind his side and embraces his abdomen with both hands, so that the patient can relax his abdomen or perform deep abdominal breathing. The abdomen repeatedly patted his abdomen with his hands. For example, the organ axis-shaped stomach twist can be pushed down from the upper abdomen with his hands, and then the patient is quickly stood upright to see if it has been restored under perspective. Kneeling and lying position rehabilitation patients take 300-500ml of barium orally, support the body with both palms and knees, and raise the abdomen slightly, so that the patient can relax the abdomen or perform deep abdominal breathing. Embracing his abdomen and patting his abdomen repeatedly, he can also use his hand to push down from the upper abdomen, and then help the patient to rotate to the right and back, and observe whether it has been restored under perspective. Squatting, jumping and rejuvenating method After swallowing a large amount of barium, the patient can make squats and standing jumps, which can also be supplemented by patting or pressing the abdomen with his hands. This method has a certain effect on the restoration of mild partial gastric torsion

(2) Automatic rotation reduction treatment under barium meal perspective The patient lies on his back on an X-ray machine, and is automatically rotated 360 ° in the specified direction under the guidance of a physician. It will automatically rotate 360 ° to the left. While turning the X-ray machine slowly while turning, the patient's rotation needs to be synchronized with the X-ray machine. Generally, one reset can be successful. If it fails to reset once, you can repeat this method several times to succeed. According to relevant literature reports, the success rate can reach 98%.

(3) Gastroscopy diagnosis and treatment Gastroscopy reduction method: After gastroscopy passes through the cardia, first inflate the gastric body cavity and then enter the cavity through the endoscope to determine the type, location, direction and degree of gastric torsion. Different methods are adopted depending on the type of gastric twist Reset. If there is too much retention fluid in the gastric cavity, you should first aspirate the liquid, and then inject the gas through the cavity into the mirror, rotate the lens counterclockwise or clockwise according to the twist direction and advance forward. If you can see the pylorus, continue to inflate to reset, sometimes Need to rotate a few times to reset. When the lateral lying can not enter the gastric antrum cavity, it is necessary to make the patient supine easily and effectively. After reduction, the patient's abdomen can be pressurized and a liquid diet can be used for 3 days.

2. Surgical treatment

Surgical treatment is divided into laparotomy and laparoscopic surgery. The former has the advantages of clear surgical exposure and easy operation, and the latter has the advantages of less surgical trauma and faster recovery. The final choice depends on the specific situation of the patient.

(1) Indications for surgery Acute complete gastric torsion; If the cause of gastric torsion (ulcer, tumor, hiatal hernia, etc.) is found to require surgery, surgery can be performed at the same time to resolve gastric torsion; Repeatedly sent to the author after conservative reduction.

(2) Surgical method After the gastric body is reset, the corresponding treatment should be performed according to the pathological changes found. For gastric ulcers, major gastric resections can be performed; radical gastric cancers can be performed due to gastric tumors; adhesions can be separated and severed; esophageal hiatus and diaphragmatic lesions can be repaired or fundus folded; if there is already gastric wall necrosis, Perforation should be repaired by gastric perforation, local resection or major resection as appropriate.
If pathological conditions that cannot be resolved by surgery are found during the operation, gastric fixation is performed. There are many types of gastric fixation. The simplest method is to fix the anterior abdominal wall (stomach the gastrocolonic ligament and the spleen and stomach ligament tightly to the anterior abdominal wall and peritoneum) or the jejunum. Anastomosis.

Gastric torsion prevention

Early detection of anatomical and pathological abnormalities that can lead to gastric torsion, and the removal of this cause, pay attention to the causes that can cause disease, early detection and early treatment.