Is it possible to twist your stomach

Alpha-loop maneuver was successfully reported to reduce 7 out of 8 cases of gastric volvulus by David et al. Despite endoscopic resolution of acute gastric volvulus with symptomatic improvements patients who are suitable candidates for surgery need elective surgery to repair the underlying hernia [ 13 ].

Endoscopic de-rotation was initially attempted in our patient but could not be accomplished. She also had evidence of pneumatosis on CT scan, which is a contraindication for endoscopic reduction. Other contraindications include any evidence of gastric ischemia, necrosis or perforation. Such patients should be taken emergently for surgery as was done in our patient.

National Center for Biotechnology Information , U. Published online Oct David P. Chen , Saqib Walayat , Imran L. Balouch , Daniel K. Martin , and Teresa J. Imran L. Daniel K. Teresa J. Author information Article notes Copyright and License information Disclaimer. Chen moc. Received Aug 4; Accepted Sep 7.

This article has been cited by other articles in PMC. Case report A year-old Caucasian female with a known moderate size hiatal hernia presented to the Emergency Department with acute onset of chest pressure, accompanied by nausea and vomiting. Open in a separate window. Figure 1. Figure 2. Figure 3. CT abdomen showed organoaxial gastric volvulus with pneumatosis of the gastric wall.

Disclosure statement No potential conflict of interest was reported by the authors. Acute gastric volvulus: diagnosis and management over 10 years. Dig Surg. Gastric volvulus. Emerg Med J. Conservative management of chronic gastric volvulus: 44 cases over 5 years. World J Gastroenterol. A case of acute mesentero-axial gastric volvulus in a patient with a diaphragmatic hernia: experience with a laparoscopic approach. J Surg Case Rep. A review article on gastric volvulus: a challenge to diagnosis and management.

Int J Surg. Volvulus of the stomach. J Natl Med Assoc. Acute stomach volvulus—case report. Biophysical Days. An urgent gastroscopy showed twisted structural abnormality of the stomach body.

A computed tomography scan demonstrated the distended stomach, located in the left lower hemithorax through a left diaphragmatic defect. Emergent transthoracic repair was performed. Postoperative recovery was uneventful, and the patient did not experience any pain or difficulty with eating.

Mostly, it happens in the fifth decade of life. It can be classified by anatomy, etiology or the axis of rotation. The most common type in adults is the organoaxial type, which means that the stomach rotates along the longitudinal axis. Acute intrathoracic gastric volvulus occurs when the stomach undergoes organoaxial torsion in the chest due to either concomitant enlargement of the hiatus or a diaphragmatic hernia [ 2 ]. An iatrogenic diaphragmatic hernia can occur following surgical procedures, such as left nephrectomy [ 3 ], esophagogastrectomy [ 4 ] and splenopancreatectomy [ 5 ], although it most frequently develops after hiatal hernia repair by either the Nissen or the Allison techniques.

The common symptoms of intrathoracic stomach are postprandial chest discomfort, dysphagia, vomiting, hemorrhage, chest fullness, inability to belch, and anemia; reflux alone is uncommon, and the signs and symptoms of acute gastric volvulus include abdominal pain and distention, especially in the upper abdomen, and vomiting with progression to nonproductive retching.

It is traditionally diagnosed by seeing intrathoracic viscera in the chest radiograph; this can be followed by a barium contrast study or upper gastrointestinal endoscopy. Currently, computed tomography CT scan can lead to an immediate diagnosis with all the anatomical details. This disease is potentially life-threatening as delayed diagnosis and treatment may result in perforation, infarction or other lethal insults [ 6 ].

Due to its rarity, however, an individual physician who has no personal experience with this disease can potentially misdiagnose it as a nonsurgical gastrointestinal disease. Here, we describe a rare complication of gynecologic surgery, an acute intrathoracic gastric volvulus due to diaphragmatic hernia occurring in a middle-aged woman who underwent total adnexal hysterectomy, salpingo-oophorectomy, omentectomy and splenectomy for treatment of cervical cancer one year earlier.

A year-old woman presented to our emergency department with a one-day history of acute moderate epigastric soreness and vomiting. She had undergone total adnexal hysterectomy and salpingo-oophorectomy secondary to cervical cancer one year previously; omentectomy and splenectomy had also been performed.

Following these operations, she had completed 9-cycle chemotherapy and had visited our hospital regularly. Upon arrival in the emergency department, physical examination revealed diffuse tenderness over the epigastric area.

Bowel sounds were hyperactive. The initial electrocardiograph was unremarkable. In contrast to a chest radiograph made three months earlier, the chest radiograph obtained in the emergency department demonstrated an elevated gastric air-fluid level in the left lower lung field fig. At first, this finding was regarded as an eventration of the diaphragm with the stomach present under the diaphragm.

As the patient complained of vomiting and epigastric soreness, an urgent gastroduodenoscopy was performed. Gastroscopy demonstrated massive fluid collection just below the gastroesophageal junction and pseudo-obstruction due to a structural abnormality of the stomach body fig.

The endoscope was not able to reach the duodenum due to this structural abnormality. These findings suggested an acute gastric volvulus. A chest CT scan demonstrated the distended stomach, located in the left lower hemithorax through a left diaphragmatic defect fig. With a working diagnosis of acute gastric volvulus with severe obstruction, emergent transthoracic repair was performed. The stomach was found in the left lower thorax with adhesions among the diaphragm, herniated stomach and left lower lobe of the lung.

The herniated stomach was reduced into the abdomen, and the diaphragm was repaired following lysing of adhesions. Chest radiographic findings. Chest radiograph at admission demonstrates a high gastric air-fluid level on the left lower lung field arrow and elevated gastric contour dotted line.

The silhouette of heart and bony thorax shows no abnormal findings, and neither does the mediastinum. Gastroscopic examination. There are no mucosal abnormalities such as hyperemia, fresh blood or old blood clots. The torsion of the stomach twisted the fundus and changed the anatomical structure so much that the fluid collection is not observed in the fundus, noticed in an ordinary situation blue arrows.

CT findings. A chest CT scan demonstrates the butterfly-like gastric wall silhouette dotted line in the left lower hemithorax.

One part of the stomach is filled with fluid yellow arrow and the other part with air blue arrow. The twisted point is observed also white arrow. Causes of intestinal obstruction may include fibrous bands of tissue adhesions in the abdomen that form after surgery; hernias; colon cancer; certain medications; or strictures from an inflamed intestine caused by certain conditions, such as Crohn's disease or diverticulitis.

Without treatment, the blocked parts of the intestine can die, leading to serious problems. However, with prompt medical care, intestinal obstruction often can be successfully treated. Because of the serious complications that can develop from intestinal obstruction, seek immediate medical care if you have severe abdominal pain or other symptoms of intestinal obstruction. Intussusception is a rare, serious disorder in which one part of the intestine slides inside an adjacent part.

In children, the most common cause of intestinal obstruction is telescoping of the intestine intussusception. Intestinal pseudo-obstruction paralytic ileus can cause signs and symptoms of intestinal obstruction, but it doesn't involve a physical blockage. In paralytic ileus, muscle or nerve problems disrupt the normal coordinated muscle contractions of the intestines, slowing or stopping the movement of food and fluid through the digestive system. Mayo Clinic does not endorse companies or products.

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