What Is Gastric Volvulus?
Gastric Volvulus or Stomach Volvulus is a rare medical condition in which there is abnormal rotation of stomach at an angle of more than 180 degrees thus creating an obstruction which is in the form of a closed loop which can cause intestinal strangulation. The classic presenting feature of Gastric Volvulus or Volvulus of Stomach is severe epigastric pain, severe retching, and an inability for an NG tube to pass through the stomach. As Gastric Volvulus is a rare entity and many cases are not diagnosed hence how often does this condition takes place is relatively unknown. This condition affects both males and females equally. Most of the cases diagnosed have been in children below one year of age but there have been cases of this condition being diagnosed in teenagers as well. Gastric Volvulus in children is caused due to congenital defects in the diaphragm.
What Are The Causes Of Gastric Volvulus?
Gastric Volvulus or Stomach Volvulus is basically of two types, Type 1 which is also called as Idiopathic Gastric Volvulus and Type 2 which is knows as Congenital or Acquired Gastric Volvulus.
Type 1 Or Idiopathic Gastric Volvulus: About 30% of cases of Gastric Volvulus are those of type 1 or Idiopathic Gastric Volvulus. This condition is commonly caused due to abnormal laxity of gastroduodenal, gastrophrenic, and gastrohepatic ligaments. This type of Gastric Volvulus is more commonly seen in adults but is also seen in children.
Type 2 Or Congenital Or Acquired Gastric Volvulus: Around 25% of people mostly children have this form of Gastric Volvulus. This is usually associated with congenital or acquired anomalies causing abnormal mobility of the stomach.
What Are Some Of The Symptoms Of Gastric Volvulus?
Acute Gastric Volvulus: The classic feature of this type of Gastric Volvulus is severe abdominal pain, retching with difficulty in passing an NG tube in the stomach. This is present in about 75% of cases of Gastric Volvulus. Studies have also shown presence of gas-filled viscus in lower chest or upper abdomen on chest x-rays and obstruction noted on upper GI series. Also noted in such cases have been severe hiccups. Intraabdominal Gastric Volvulus commonly presents itself as sudden onset severe epigastric or left upper quadrant pain. Intrathoracic gastric volvulus presents itself as a sharp chest pain going towards the left side of neck, shoulder, arms, and back. In some cases there may be observation of hematemesis which is quite serious and can quickly progress to hypovolemic shock.
Chronic Gastric Volvulus: Individuals with this type of Gastric Volvulus or Volvulus of Stomach present with intermittent epigastric pain along with abdominal fullness after eating a meal. Individuals may also report early satiety, dyspnea, and chest pain in some cases. In case if there is some abnormality in the GE junction then there may also be dysphagia.
How Is Gastric Volvulus Diagnosed?
If a detailed physical examination is conducted for confirming Gastric Volvulus in an individual, it may reveal inconclusive results as there are many more conditions which mimic the symptoms produced by Gastric Volvulus hence more invasive studies in the form of radiographic studies, imaging, and upper GI series are done for a more confirmatory diagnosis of Gastric Volvulus. Imaging in the form of CT scan usually confirms the presence of Gastric Volvulus. An endoscopy may also confirm the diagnosis of Gastric Volvulus. If a chest x-ray is taken it will show gas-filled viscus which also confirms diagnosis of Gastric Volvulus or Volvulus of Stomach. Abdominal radiographs will reveal massively distended viscus in upper abdomen. Another way to confirm the presence of Gastric Volvulus is to conduct an Upper GI series. This is done using barium and virtually confirms the presence of Gastric Volvulus.
What Is The Treatment For Gastric Volvulus?
The mainstream treatment for Gastric Volvulus or Volvulus of Stomach is emergent surgical repair, although in those patients who are not good surgical candidates endoscopic reduction is the treatment of choice. The surgical procedure to treat Gastric Volvulus is done using the laparoscopic approach. Some of the conditions which may make a patient a poor candidate for surgical repair is intolerance of anesthesia.
Once an individual is diagnosed with Gastric Volvulus or Stomach Volvulus, the patient is medically cleared and prepared for surgery to correct the obstruction. The individual is also administered analgesics and anti-vomiting medications.
Endoscopic Reduction: In this method an endoscope is inserted via the mouth and inserted to the stomach beyond the point of the volvulus and then rotated to correct the volvulus of the stomach. This mode of treatment is applicable for those individuals who are poor candidates for surgery. Post endoscopic reduction, an endoscopic gastrostomy tube is placed to prevent recurrence.
Is There Any Recommended Diet Plan For Gastric Volvulus Or Volvulus Of Stomach?
Yes, there are certain dietary modifications which can be done pre and post treatment for individual affected with Gastric Volvulus or Volvulus of Stomach. Some of the dietary modifications are as mentioned below:
- The affected individual will need to eat more small meals instead of one large meal in a day so that the digestive system is not under pressure to digest large amounts of food at one time and also provide the body with adequate nutrition.
- In cases of Volvulus, especially postsurgery, it is recommended that the individual if possible stay away from foods rich in fiber like apples, nuts, broccoli, and instead try and consume a bland diet. It is also recommended to stay away from spicy or fried foods as it is difficult to digest and it may also slow down the healing process.
- Avoiding constipation is also necessary in Volvulus and constipation may occur especially if there is reduced fiber intake. Thus, it is recommended that the individual consume plenty of water to avoid constipation.
- In case if an individual is diagnosed with Volvulus, it is recommended to take care of the diet as Volvulus even after being treated has a tendency to recur. Since some of the intestine is removed during surgery for Volvulus the body finds it difficult to absorb vital minerals and vitamins; therefore, it becomes necessary for the individual to be on electrolyte replacement so that the body does not get devoid of any vital electrolytes or minerals.
What is The Normal Diet to be Followed After Surgery for Gastric Volvulus?
Patient after abdominal or chest surgery may not be able to eat normal diet for several days. Surgery on gastrointestinal system may be followed nothing by mouth for 10 to 15 days. In all other surgery the oral intake or oral diet initiation depends on type of anesthesia given to patient. Surgery is performed either under general, regional or local anesthesia. The general anesthesia often causes nausea and vomiting for 24 to 48 hrs. In such cases liquid diet is preferred for 1 to 2 days after surgery. The deep or light sedation is given when surgery is performed under regional anesthesia like spinal, epidural or nerve block. Sedation like general anesthesia may cause nausea and vomiting for 24 hours. Brain surgery, surgery of mouth and oral cavity also delays the oral feeding or intake of food by mouth. In short the time of initiation of oral feeding depends on type of surgery and anesthesia.