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Incredible Stomach Stories: Why Do Some People Get Gastric Torsion?
Gastric volvulus, also known as gastric curling, is when all or part of the stomach is twisted by more than 180 degrees, causing obstruction of material flow, which may cause changes in blood supply and tissue death. The twisting can occur around the long axis of the stomach, called the organoaxial, or around an axis perpendicular to it, called the mesenteroaxial. In torsions of the organ axis, obstruction is more likely, whereas the mesenteric axis is more likely to be associated with ischemia. About one-third of cases are associated with diaphragmatic hernia, and treatment usually requires surgical intervention.
The classic triad (Borchardt's Triad) described by Borchardt in 1904 is the characteristics of gastric volvulus, including severe upper abdominal pain, retching without vomiting (sour taste in the mouth), and inability to pass a nasogastric tube.
Types of gastric volvulus
Organ axial type
In axial gastric torsion of the organ, the stomach rotates about the axis connecting the gastroesophageal junction and the pylorus, with its lower part rotating in the opposite direction relative to the upper part of the stomach. This is the most common type of gastric volvulus, accounting for approximately 59% of cases, and is usually associated with a defect in the diaphragm. Axial twisting of the organ is often accompanied by snagging and necrosis, and reports indicate this occurs in 5% to 28% of cases.
Mesenteric axial type
Axial torsion of the mesentery rotates the lower part of the stomach anteriorly and superiorly, causing the posterior surface of the stomach to face forward. This type of rotation is usually incomplete and sporadic, and vascular compromise occurs relatively infrequently, accounting for approximately 29% of gastric volvulus cases.
Union type
Combined gastric volvulus is a rare type in which the stomach twists in both the mesenteric and organ axial directions. This type of gastric volvulus accounts for the remaining cases and usually occurs in patients with chronic volvulus.
Causes of gastric torsion
First type
The cause of the first type of gastric volvulus is unknown, accounting for about two-thirds of the total cases. It is speculated that it may be caused by abnormal relaxation of the spleen-gastric ligament, gastroduodenal ligament, gastrophrenic ligament, and gastrohepatic ligament.
Second type
Type 2 gastric volvulus occurs in one-third of patients and is usually related to congenital or acquired abnormalities that cause the stomach to move abnormally.
Diagnostic methods
A gas-filled distended stomach in the retrocardiac space may be seen on a chest X-ray, which can help confirm the diagnosis. A flat abdominal X-ray may show significant distension of the upper abdomen. A plain radiograph taken in the axial direction of the organ may show a horizontally oriented stomach with a single air-fluid level and less air downstream. In mesenteric axial gastric volvulus, radiographic examination of the flat abdomen shows a globular stomach on recumbent images, whereas upright images show two air-fluid levels and the lower part of the stomach is superior to the gastroesophageal junction.
Upper gastrointestinal tract research
Diagnosis of gastric volvulus is usually based on barium contrast studies; however, some recommend computed tomography as the first imaging option. Contrast radiography of the upper gastrointestinal tract has high sensitivity and specificity for diagnosing gastric volvulus. ',
It can quickly diagnose conditions based on several coronal reconstruction images, quickly determine whether there is gas and free air in the stomach, detect risk factors (such as diaphragmatic hernia or hiatal hernia) and rule out other abdominal pathologies.
Endoscopy
Upper gastrointestinal endoscopy can help diagnose gastric volvulus. When this examination reveals anatomic abnormalities of the stomach and difficulty accessing the stomach or pylorus, it may strongly suggest the presence of gastric volvulus. If gastric volvulus reaches advanced stages, the noose on the blood supply may lead to the gradual development of ischemic ulcers or mucosal fissures. In addition, the non-surgical mortality rate of gastric volvulus is as high as 80%.
With the advancement of diagnosis and treatment methods
The historical mortality rate of acute gastric volvulus has dropped from the initial 30%-50% to 15%-20%, while the mortality rate of chronic gastric volvulus is between 0%-13%. The main cause of death is still due to gastric volvulus. of the noose, which may lead to necrosis and perforation.
Although the occurrence of gastric volvulus is uncommon, it is crucial to seek medical treatment in time if the above symptoms and imaging characteristics occur. Have you ever heard stories about gastric torsion and wondered if you might face such a health challenge?
