What Is Gastric Volvulus?

Did you know that volvulus means “to roll” in Latin? Once combined with gastric which means “stomach”, the condition becomes self-explanatory.²

Gastric Volvulus is a rare clinical condition where the stomach twists on itself and cuts its blood supply, which can lead to life-threatening situations if left untreated.²

This article provides insight into the following topics relating to gastric volvulus:

• Cause of gastric volvulus
• Signs and Symptoms of gastric volvulus  
• Management and treatment for gastric volvulus

Overview

Gastric volvulus is a clinical condition where the stomach rotates on itself by more than 180 degrees. The condition is caused by an obstruction in the foregut, which is the first part of the digestive tract. This increases the risk of necrosis, perforation, and shock in the stomach, leading to stomach strangulation. Gastric volvulus can be very intense for short periods, referred to as acute gastric volvulus, or can become chronic if the symptoms recur and last longer. More than half of gastric volvulus cases prove fatal, highlighting the significance of early diagnosis and treatment of the condition.^1,2 

Causes of gastric volvulus

Gastric volvulus commonly affects children who are younger than one year of age as well as older adults, who are older than 50 years of age.³ The most common cause of gastric volvulus in adults and children is a hiatal hernia. A hiatal hernia in a newborn can be the result of a birth defect, where there is an abnormally large opening (the hiatus)in the diaphragm that allows the stomach to be partially displaced into the chest. In the instance of a hiatal hernia, the gastro-oesophageal junction (GOJ) moves from underneath the diaphragm into an aberrant position in the chest. When severe symptoms of this condition occur, it is usually identified as organoaxial gastric volvulus. Yet, gastric volvulus can also be caused by the weakening or the absence of stomach ligaments, gastric tumours and the poor development of the spleen.^2,3,4 

Organoaxial gastric volvulus is caused by the stomach rotating around a line extending from the bottom part of the stomach junction (the pyloric sphincter), along the longitudinal axis. This form of gastric volvulus is seen in the majority of cases that have pre-existing disorders or defects of the stomach, the spleen, or the diaphragm.⁴ Mesenteroaxial gastric volvulus is a less common variant of gastric volvulus that is caused by the rotation of the stomach around a line that spans from the greater to the lesser curvature of the stomach.⁵

Signs and symptoms of gastric volvulus  

There are two ways in which gastric volvulus can present itself. It can be an acute emergency or it can manifest as a chronic condition. Since gastric volvulus has a variety of different causes, many symptoms can manifest. These symptoms may include serious complications, like peritonitis, due to the walls of the stomach becoming damaged as a result of the stomach twists, allowing bacteria to enter the abdominal cavity and cause inflammation. It can also cause partial or complete bowel obstruction, leading to difficulty passing stools and severe abdominal pain.^1,2

Additionally, gastric volvulus can also cause severe vomiting, which can result in dehydration and electrolyte imbalances. Acid reflux may also occur due to decreased pressure in the stomach, allowing stomach acid to flow back into the oesophagus. Therefore, It is important to quickly identify and treat this condition to prevent infarction and perforation, which can be life-threatening.^6,7 

Management and treatment for gastric volvulus

When a patient presents with acute gastric volvulus, the conventional treatment has always been immediate surgery to untwist the volvulus. Surgery is necessary if there is stomach necrosis or perforation, and the diaphragmatic hernia must be reduced and closed. The stomach can be fixed to the abdominal wall with sutures. Open surgery. or a combination of laparoscopic and endoscopic techniques, are effective. Laparoscopy is less invasive for chronic or intermittent gastric volvulus. Patients who are fit enough to withstand surgery should have their chronic gastric volvulus repaired to avoid the high morbidity and mortality associated with strangulated gastric volvulus.^6,8 

Although surgery is still the best approach, medical management may be attempted in high-risk patients. Medications, to help reduce your discomfort and prevent further episodes, include proton pump inhibitors that reduce the pressure in the stomach, antibiotics to treat bacterial infections, and antispasmodics to ease abdominal pain and cramping by relaxing the muscles in your digestive tract. In some higher-risk elderly patients, endoscopic surgery can be used to decompress and reduce the stomach size, as well as to install a percutaneous gastrostomy tube. However, patients with gastric volvulus must be examined for critical issues before surgery to prevent sepsis or infection during the surgery.^5,6,8 

Diagnosis of gastric volvulus

Diagnosing gastric volvulus can be challenging, but a thorough medical history and physical examination can provide physicians with signs of the condition. To confirm the diagnosis when the symptoms are present, physicians may use chest X-rays or upper gastrointestinal contrast studies. Suspicious chest X-rays may show a spherical stomach and double air-fluid level while contrast studies may reveal a gastric air-fluid level above the diaphragm, a lack of distal bowel gas, a reversed position of the greater curvature of the stomach, and a downward-pointing pylorus, the bottom part of the stomach that connects to the intestine. 

Barium swallow tests and computed tomography (CT) scans of the chest, abdomen, and pelvis can also help diagnose gastric volvulus. The use of abdominal CT can provide crucial information about the patient's stomach anatomy and help with surgical intervention. However, it is important to note that CT scans can also be performed on non-responsive patients who are in a critical condition.^2,8

FAQs

How common is gastric volvulus?

Although the rate of incidence of gastric volvulus is not known, the condition is hypothesised to be rare. ⁹

How can I prevent gastric volvulus?

To prevent the occurrence of gastric volvulus, you should maintain a healthy body weight and eat a balanced diet. Participating in physical activity, avoiding abdominal strain, and seeing a doctor if symptoms arise are also key to avoiding complications associated with the condition. In patients with a hiatus hernia, immediate surgical intervention is needed to avoid gastric volvulus.

Who is at risk of gastric volvulus?

Gastric volvulus can occur in any individual, however, most often it is seen in young children, below the age of five, and in older adults who are above the age of 50.³ 

When should I see a doctor?

Early diagnosis of gastric volvulus is recommended, which means if you experience any signs or symptoms associated with gastric volvulus, such as abdominal pain, vomiting, bloating or difficulty swallowing, it is recommended to see your local physician.

Summary

Gastric volvulus is a rare condition caused by abnormal stomach rotation and mobility resulting in an obstruction to the foregut, which can lead to serious complications. It can be acute or chronic and can be caused by a hiatal hernia or a disorder of the stomach, spleen, or diaphragm. It is important to quickly identify and treat this condition to prevent the death of stomach tissue and perforation. Diagnosing gastric volvulus requires a thorough medical history and physical examination, as well as chest X-rays, upper gastrointestinal contrast studies, barium swallow tests, and CT scans. Surgery is the gold standard treatment for acute gastric volvulus, but medical management may be attempted in high-risk patients.