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Gastric Volvulus

What is Gastric Volvulus?

This medical condition happens when all or part of your stomach twists around by more than 180 degrees and causes a blockage of your gut. It is sometimes possible for your stomach to rotate far enough so the blood supply could become cut off and lead to gangrene. Approximately twenty percent of the cases of gastric volvulus happen in children and more than half happen before they are one year old but are more common in adults. You will find this medical condition more commonly in the elderly as their stomach’s supporting ligaments are becoming more lax as they age.

Types

  • Acute gastric volvulus – with this type it happens suddenly and is considered an emergency needed surgical treatment. When a physician tries to pass a tube down into the stomach they will find it impossible to do so.
  • Organoaxial gastric volvulus – this type involves your stomach revolving along its length and more frequently associated with the blood supply being cut off to your stomach. Fifty-nine percent of all cases of gastric volvulus are this type.
  • Mesenteroaxial gastric volvulus – this type occurs when your stomach flips upside down with the back of your stomach ending up facing the front of your body. This happens occasionally and is less likely to completely obstruct the blood supply to the stomach or block the gut. It can give rise to what is called a chronic condition, which means that over a long period of time the symptoms come and go. Approximately twenty-nine percent of the cases of gastric volvulus are mesenteroaxial type.
  • Combined type – this is a rare form in which the stomach twists organoaxially and mesentericoaxially.

Gastric Volvulus Symptoms

The symptoms that a person displays with gastric volvulus depend on which type they are experiencing.

  • Acute gastric volvulus – severe pain just below your breastbone, retching without being able to properly vomit. You may also have breathlessness and swelling of the upper abdomen with the lower abdomen remaining flat and feeling soft. There are some cases where the pain can travel from the chest along your arms and up to your neck.
  • Mesenteroaxial gastric volvulus – when this type gives rise to a chronic condition you may have pain below your breastbone that you feel now and then along with a feeling fullness soon after you start to eat. You may also have problems with swallowing and breathlessness.

Causes

Approximately one third of all gastric volvulus cases are associated with a hiatus hernia, which is a protrusion of the upper part of your stomach into the area between your neck and stomach called the thorax. It comes into your thorax through a weakness or tear in your diaphragm. Gastric volvulus is also more commonly found in people who have birth defects, also known as congenital abnormalities, of their diaphragm.

It can also be caused by:

  • Having no spleen
  • Gastric, or stomach, ligaments that are too long
  • Weak muscles, referred to as motor neurone diseases
  • Tumor of the stomach
  • Any other defects that can affect your stomach

If you have a defect of your diaphragm you would most likely suffer from organoaxial volvulus.

Diagnosis

It is usually diagnosed by having x-rays taken, which will show the gastric volvulus as an air-filled sac behind the heart shadow on a chest x-ray. If they do an x-ray of your stomach it may show that a part of your stomach as being massively distended. Your physician may have a barium meal done, which is a special type of x-ray. You will be given a toothpaste-like gel that you swallow to provide contract. After you have swallowed it the x-ray will be taken. It will show the absence or narrowing of the barium substance in the part of your stomach where the obstruction is located. You may also have a CT-scan done to show the entire anatomy of your stomach, which makes precise diagnosis possible along with showing what the obstruction is. A CT-scan may also give the physician a clue as to what caused the gastric volvulus to begin with.

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Treatment

The treatment needed depends on which type of gastric volvulus you are experiencing.

Acute gastric volvulus – the treatment for this type is surgery

Surgery and Repair

When you have surgery for acute gastric volvulus it is done to repair the problem by untwisting your stomach and fixing it into place so this does not happen again. If there is any presence of gangrene during the surgery that tissue is also removed. Before your stomach can be fixed to the diaphragm and anterior abdominal wall it will have to be tested for viability, which means they need to make sure that it has not turned gangrene and will still function the way the stomach should function. The surgery to repair gastric volvulus is called anterior gastropexy and is considered an emergency surgery. After surgery you will be in the hospital for a couple of days before you are discharged to make sure that the surgery fixed the problems and there are no complications from the surgery.

In some cases of gastric volvulus the surgeon may use an endoscope, which is a thin long instrument that is similar to a telescope, to do keyhole surgery. With this type it is repaired by rotating your stomach back to the original position but the drawback with keyhole surgery is that there is a risk of perforating your stomach wall. This type of surgery is useful for those who are not fit enough to have open surgery, as what is done for acute gastric volvulus. Keyhole surgery may be done as a temporary measure and have the traditional surgery done later. If there have been any defects in the wall of your diaphragm that may have caused your case of gastric volvulus they will also have to be repaired.

Surgery Recovery time

If you have had open surgery to fix your case of gastric volvulus it can take two to six weeks before you are fully recovered. During this time you should not be putting this area under a lot of stress and stretches and taking it easy.


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