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Secrets of First Aid Knowledge: What Should You Do When Gastric Torsion Occurs?
Gastric volvulus, also known as gastric torsion, is a rotation of all or part of the stomach more than 180 degrees, resulting in intestinal obstruction with possible loss of blood supply and tissue death. Gastric volvulus can be divided into two main types, depending on the direction of rotation: longitudinal axis volvulus and mesenteric axis volvulus. Regardless of the type, seeking prompt medical attention is crucial to diagnosing and treating gastric volvulus.
Types of Gastric VolvulusThe classic triad of gastric volvulus (Borchardt's Triad) includes severe epigastric pain, regurgitation (a sour taste in the mouth without vomiting), and inability to pass a nasogastric tube, which is reported to occur in 70% of cases.
Longitudinal axis torsion
In this condition, the stomach rotates around the axis connecting the esophagus to the pylorus. The lower part of the stomach (the antrum) and the upper part (the top of the stomach) rotate in opposite directions. Longitudinal axis torsion is the most common type, accounting for approximately 59% of cases and is usually associated with a diaphragmatic defect.
In this type of gastric volvulus, intestinal colic and necrosis are reported in 5%-28% of cases.
Mesenteric axial torsion
This type of rotation occurs primarily in the front and top of the stomach, causing the back surface of the stomach to appear in front. This condition is usually intermittent and incomplete; compromised vascular supply is uncommon, occurring in approximately 29% of cases.
Combined twist
This is a rare type of gastric volvulus that involves both mesenteric and longitudinal torsion, and most cases occur in patients with chronic volvulus.
Causes of Gastric Torsion
Type 1
Unexplained gastric volvulus accounts for two-thirds of all cases and is mainly due to abnormal relaxation of the gastrosplenic, gastroduodenal, gastric diaphragmatic and hepatogastric ligaments. Type I gastric volvulus is more common in adults but has also been reported in children.
Type 2
Type II gastric volvulus occurs in patients who present with more extensive congenital or acquired abnormalities that cause the stomach to move abnormally.
Diagnostic Methods
Chest X-rays can demonstrate gas filling behind the heart to confirm the diagnosis of an intrathoracic cyst of the stomach. A plain abdominal X-ray can reveal a large amount of distended bowel in the upper abdomen. In cases of longitudinal axial volvulus, planar x-rays may show a transversely oriented stomach with a single air-fluid level and a lack of distal air. In a plane abdominal X-ray of mesenteric axial volvulus, a spherical stomach is presented in the supine position and two air-fluid levels in the upright position, with the antrum higher than the top of the stomach.
Upper gastrointestinal examination
The diagnosis of gastric volvulus is usually based on barium examination, but modern medicine has recommended computed tomography (CT) as the preferred imaging modality. Upper gastrointestinal tract contrast imaging can provide sensitive and specific results in gastric "volvulus" states.
The benefits of CT scanning include rapid diagnosis, the ability to identify gas bubbles and free air in the gastrointestinal tract, detection of potential causes (such as diaphragmatic or hiatal hernia), and exclusion of other abdominal pathologies.
Endoscopy
Upper endoscopy is also helpful in diagnosing gastric volvulus and is highly indicative when this procedure demonstrates an abnormal structure of the stomach that makes intubation difficult.
Even with advances in diagnosis and management, the nonsurgical mortality rate for gastric volvulus can be as high as 80%. To improve diagnosis and treatment outcomes, timely medical attention is critical.
ConclusionBy understanding the causes, types and recommended diagnostic methods of gastric volvulus, people can better recognize this emergency, helping them to respond quickly when necessary. So, when faced with the possibility of urgent medical intervention, are we prepared to take the right action?
