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The Mystery of Stomach Rotation: Why Does Gastric Torsion Cause Severe Pain?
Gastric volvulus, or gastric rotation, is a stomach condition in which part or all of the stomach rotates more than 180 degrees, affecting the flow of food through the stomach and potentially leading to poor blood supply and tissue death. This twisting can occur about the long axis of the stomach (called the organ axis) or about an axis perpendicular to it (called the mesenteric axis), with twisting in the organ axis being more likely to cause obstruction. According to the study, about one-third of cases are related to hiatal hernia, which generally requires surgery.
Types of Gastric VolvulusThe classic triad of gastric volvulus, called Borhart's triad, includes severe upper abdominal pain, retching without vomiting, and inability to pass a nasogastric tube.
Gastric torsion can be divided into different types, depending on the pattern of twisting:
Organ Axial Type
In axial gastric volvulus, the stomach rotates around the axis that connects the esophagus to the pylorus. In this condition, the fundus of the stomach rotates in the opposite direction, accounting for about 59% of cases. It is often associated with a diaphragmatic defect and is prone to strangulation and necrosis.
Mesenteric axial type
Mesenteric axial type gastric volvulus occurs when the front and upper parts of the stomach rotate so that the back side becomes the front side. This type of torsion is usually incomplete and does not cause blood supply problems in most cases, accounting for about 29% of cases.
Compound type
Complex gastric volvulus is a rare condition in which the stomach twists on both the mesenteric and organ axes and is usually seen in patients with chronic illness.
Causes of Gastric Torsion
Unknown cause type
About two-thirds of gastric volvulus cases are caused by abnormal relaxation of the ligaments surrounding the stomach, a condition called type I gastric volvulus. This condition is more common in adults, but has also been reported in children.
Associated with congenital or acquired abnormalities
Type II gastric volvulus accounts for about one-third of cases and is usually related to the patient's congenital or acquired gastric abnormalities, causing abnormal gastric activity.
Diagnostic Process
The diagnosis of gastric volvulus is usually based on a chest X-ray, which shows the stomach being inflated with air. An abdominal X-ray may show a distended stomach. Organoaxial gastric volvulus X-ray images will show a transverse stomach with a single air-fluid level.
Contrast studies of the digestive tract (such as barium radiography or gastrografin) are also very sensitive for the diagnosis of gastric volvulus and can show the stomach in a "twisted" state.
Endoscopic diagnosis
Upper endoscopy can help diagnose gastric volvulus and is particularly indicative when the examination reveals a distortion of the stomach structure. As the disease progresses, blood supply restriction can lead to organ ischemia and ulcers.
Risk and mortality
The non-surgical mortality rate of gastric volvulus has been reported to be as high as 80%. With advances in diagnosis and management, the mortality rate of acute gastric volvulus has dropped to 15-20%. However, the mortality rate of chronic gastric volvulus is between 0 and 13%.
ConclusionThe main cause of death from gastric volvulus is gastric colic, which may lead to necrosis and perforation.
Although gastric torsion is a dangerous medical problem, with the advancement of medical technology, many patients can receive timely treatment and care. However, in our daily lives, it is always important to pay attention to gastrointestinal health and its potential risks. Should we be more alert whenever we face severe abdominal pain?
