Gastric volvulus occurs when the stomach twists round, causing a blockage of the gut. Sometimes it is possible for the stomach to rotate far enough that the blood supply may become cut off, leading to gangrene. In acute gastric volvulus, which happens suddenly, symptoms include severe pain just below the breastbone and retching without being able to vomit properly. The physician will find it impossible to pass a tube down into the stomach. Acute gastric volvulus is an emergency and usually requires surgical treatment.
Most often, gastric volvulus involves the stomach revolving along its length. This is known as organoaxial gastric volvulus, and it is more frequently associated with the blood supply to the stomach being cut off. Occasionally, a variation called mesenteroaxial gastric volvulus occurs, where the stomach flips upside down and the back of the organ ends up facing the front of the body. This is less likely to completely block the gut or obstruct the stomach's blood supply, and may give rise to what is termed a chronic condition, where symptoms occur on and off over a longer period. Gastric volvulus occurs more commonly in elderly people, due to the stomach's supporting ligaments becoming more lax with age.
In the acute form of the condition, as well as pain and retching, there may be swelling of the upper abdomen and breathlessness. The lower abdomen might remain flat and feel soft. In some cases, pain can travel from the chest along the arms and up into the neck.
The chronic condition is more difficult to diagnose, with pain below the breastbone being experienced now and then. A feeling of fullness soon after beginning a meal might occur, together with breathlessness and problems with swallowing. As the symptoms are vague, the condition can be confused with other illnesses such as duodenal ulcers.
Gastric volvulus is usually diagnosed using X-rays, and treatment for the acute condition involves surgery to untwist the stomach and fix it in place to prevent recurrence. At the same time, any tissue which has died as a result of gangrene is removed. In some cases of chronic volvulus, an endoscope — a long thin instrument similar to a telescope — may be used to carry out keyhole surgery. This technique can be used to rotate the stomach back into its original position, but there is a risk of perforating the stomach wall. It is useful for patients who are not fit enough to cope with open surgery; it may be carried out as a temporary measure, with traditional surgery planned for a later date.