Gastric volvulus is a condition where the stomach has rotated along it’s long or short axis, leading to gastric outlet obstruction and the prevention of digested products from entering the intestine. It may also be referred to as having a “twisted stomach.” Gastric volvulus symptoms may present acutely (suddenly) or chronically (over time), with the potential of leading to ischemic damage.
Fortunately, gastric volvulus is a rare condition, with 80–90 percent of adults developing it after the age of 50. Gastric volvulus occurs equally in both males and females and appears similarly among races.
What are the types of gastric volvulus?
Acute gastric volvulus: Occurring suddenly and is considered an emergency situation requiring surgical intervention. Doctors will be unable to pass a tube down into the stomach with this condition.
Organoaxial gastric volvulus: Characterized by the stomach revolving along its length. It is also the most frequent type associated with strangulation of the stomach’s blood supply. Organoaxial type accounts for almost 60 percent of all cases of gastric volvulus.
Mesenteroaxial gastric volvulus: This is when the stomach flips upside down with the back of the stomach facing forwards. This type infrequently leads to blood supply obstruction but can give rise to a more chronic condition of gastric volvulus. Mesentroaxial type accounts for about 30 percent of all cases of gastric volvulus.
Combined type: A rare form of gastric volvulus where the stomach twists organoaxially and mesentericoaxially.
What are the causes and symptoms of gastric volvulus?
The stomach is an organ that contracts and relaxes when breaking down food for digestion. These contractions have the ability to move the stomach a significant degree but it is prevented from doing so by its proximity to organs around it. These organs are the omentum — tissue that keeps organs in place — and the gastrosplenic, gastroduodenal, gastrophrenic, and gastrohepatic ligaments.
Despite these structures existing, there are times when gastric volvulus can occur regardless. This is termed “idiopathic” or occurring due to unknown causes. Idiopathic gastric volvulus (type 1) accounts for nearly two-thirds of all cases and is more common in adults. However, some cases have been reported in children.
The ligaments holding the stomach in place have a degree of flexibility but are rigid enough to help keep the stomach in its position. If these ligaments were to lose their ability to do their job, the chances of the stomach twisting on itself become more likely. It is presumed that this is the case for all idiopathic causes of gastric volvulus.
Individuals suffering from congenital defects of the stomach structures are predisposed to gastric volvulus. Congenital gastric volvulus (type 2) means an individual is born with a defect that allows their stomach to move more liberally, making them more prone to the condition. However, defects may also be inflicted during the course of life. These are termed “acquired causes.” Some gastric volvulus causing defects include:
- Defects of the diaphragm
- Defects of the gastric ligaments
- Adhesions or bands that may attach to the stomach — a complication of abdominal surgery
- A lack of spleen or an under-functioning spleen, reducing the support of the stomach by neighboring organs.
Depending on the degree of gastric rotation, symptoms of gastric volvulus vary. Symptoms may also be mistaken for more benign causes of stomach pain. The following are signs and symptoms of gastric volvulus that may occur:
- Abdominal pain in the upper middle or left upper quadrant
- Sharp chest pain radiating to the shoulder, neck, arm or back on the left side
- Abdominal distension
- Vomiting of blood (rare)
How to diagnose gastric volvulus
Patients will often present with acute or chronic stomach pain. The doctor will take a complete medical history and perform a physical examination. There are many conditions that can present with stomach pain, and these need to be ruled out before diagnosing gastric volvulus.
Radiologic studies will be implemented next, which will provide a direct view of the structure and position of the stomach itself. An upper gastrointestinal series of images will be done to confirm the diagnosis. A computer tomography scan (CT scan) will often be sufficient to check if gastric volvulus is present. However, if deemed necessary, an endoscopic examination may be utilized.
Radiographic feature will often present with the following depending imaging tests used:
Plain radiograph (X-ray)
- Double air-fluid level, distended stomach, collapsed small bowel
- Distended stomach
- Volvulus with >180° twist
- “Beaking” may be demonstrated at point of twist
- Incomplete or absent entrance of contrast material into and/or out of stomach is indicative of acute obstructive volvulus
Computer tomography (CT)
- Linear septum may be visible within the gastric lumen
- Entire stomach may be herniated
- Ischemia seen as lack of contrast enhancement of gastric wall
How to treat gastric volvulus
Treatment of gastric volvulus will depend on whether it’s an acute or chronic case of the condition. Acute cases are considered an emergency and require immediate surgical correction.
Surgical repair of the stomach structures aimed at keeping it in place is the most common treatment of gastric volvulus. In those who are not good surgical candidates, endoscopic reduction is utilized to minimize surgical trauma and complication. Endoscopic reduction is a procedure where an endoscope is inserted into the mouth and down into the stomach beyond the point of the volvulus. The stomach is then rotated into the correct position.
Typical surgical procedures are done by making small surgical incisions into the abdominal cavity and inserting slender tools. This is called a laparoscopic surgery and has the benefit of decreased healing times.
Before surgery is done, the patient is prepped. They are also given analgesics and anti-vomiting medication. Gastric decompression with a nasogastric tube may also be implemented if required. However, care should be taken when placing the nasogastric tube, as it may cause perforation.
After surgery, patients will be admitted to the hospital for a couple of days for observation. This is done to make sure that the surgery was successful and there are no resulting complications. If open surgery was done, it can take up two to six weeks for full recovery.
Gastric volvulus diet
While the general consensus is that surgery is the recommended line of treatment, there are some dietary recommendations you can follow before and after surgery. These include:
- Eating smaller meals throughout the day. This reduces the work the stomach has to do.
- Avoiding fiber-rich foods, including apples, nuts, and broccoli. as they cause increased stress on the stomach and intestines.
- Avoid fried and spicy foods, as they are harder to digest and may slow down the healing process post surgery.
- Drink plenty of water.
Prognosis of gastric volvulus
Those who do not seek treatment for gastric volvulus reportedly have a mortality rate as high as 80 percent. However, historically, these numbers have ranged between 30 and 50 percent for acute cases, with the major cause of death being strangulation of the intestinal tract leading to necrosis and perforation. With advances in diagnosis techniques, acute gastric volvulus is now 15–20 percent.
Gastric volvulus is a serious condition if left untreated. It is highly advised to speak to a medical professional if gastric volvulus is suspected or you have frequent symptoms of unexplainable abdominal pain. If gastric volvulus is diagnosed, you can rest assured that with the care of an experienced doctor, you will be treated successfully.