Gastric displacement

Introduction Volvulus of stomach is a fixed mechanism of the normal position of the stomach or its adjacent organ lesions cause gastric displacement. X-ray examination can often help to confirm the diagnosis when the patient has the above clinical features and suspected gastric torsion. For acute gastric torsion, as long as the disease can be thought of, there is no difficulty in diagnosis. Most of the adult gastric torsion has anatomical factors and is caused by different incentives. The normal position of the stomach mainly depends on the fixation of the lower end of the esophagus and the pylorus. The liver and stomach ligament, the gastric collateral ligament, and the gastric spleen ligament also have a certain fixation effect on the stomach and small curvature.

Cause

(1) Causes of the disease

Neonatal gastric torsion is a congenital malformation, which may be related to poor rotation of the small intestine, which may cause gastric spleen ligament or gastric colon ligament to relax and cause poor gastric fixation. Most can be corrected by the baby's growth and development.

Most of the adult gastric torsion has anatomical factors and is caused by different incentives. The normal position of the stomach mainly depends on the fixation of the lower end of the esophagus and the pylorus. The liver and stomach ligament, the gastric collateral ligament, and the gastric spleen ligament also have a certain fixation effect on the stomach and small curvature. Larger esophageal hiatus hernia, septum, bulge and excessive relaxation of the peritoneum of the duodenal descending segment make the lower esophageal and pyloric parts of the esophageal hiatus difficult to fix. In addition, the sagging of the stomach and the large or small ligaments of the small curved side are loose or too long, which are the anatomical factors of the onset of gastric torsion.

Acute gastric dilatation, acute colonic bloating, overeating, severe vomiting, and reverse motility of the stomach can be the driving force for sudden changes in the position of the stomach, and are often the cause of acute gastric torsion. Inflammation and adhesion around the stomach can involve the stomach wall and cause it to be fixed in an abnormal position. These lesions are often the cause of chronic gastric torsion.

(two) pathogenesis

1. According to the rotation direction

(1) Torsion along the long axis: that is, the line connecting the cardia and the pylorus is the axis and is turned upside down. This type of disease is rapidly onset, with obstructive obstruction and rapid gastric expansion.

(2) Left and right twist: The midpoint of the curve bent by the size of the stomach is the axis, and is twisted to the left or right. Chronic or intermittent, obstructive symptoms are not obvious.

2. According to the range of torsion

(1) Complete torsion: Except for the sacral portion, the entire stomach is twisted forward and upward, with a large bend on the upper side, between the liver and the diaphragm, and the posterior wall of the stomach forward.

(2) Partial torsion: mostly distal to the stomach, partially twisted forward or backward.

3. According to the twisting process

(1) Acute torsion: the attack is sharp and the symptoms are severe.

(2) Chronic torsion: manifested as persistent or recurrent, easily mistaken for gastric ulcer or hiatal hernia.

an examination

Related inspection

Gastrointestinal CT examination of gastrointestinal imaging

Diagnosis of gastric displacement:

X-ray examination can often help to confirm the diagnosis when the patient has the above clinical features and suspected gastric torsion. For acute gastric torsion, as long as the disease can be thought of, there is no difficulty in diagnosis. If the trial is inserted with a gastric tube to confirm, it should be inserted slowly and cannot be forced to avoid damage or perforation of the stomach wall. Chronic gastric torsion is not completely specific due to incomplete obstruction, and clinical diagnosis is difficult.

Differential diagnosis

Differential diagnosis of gastric displacement:

1. Acute gastric dilatation: The abdominal pain is not serious in this disease, but the above abdominal distension is the main, nausea and frequent vomiting. The vomit contains bile and has a large amount of vomiting; it can be inserted into the stomach tube and extract a large amount of gas and liquid. Patients often have signs of dehydration and alkalosis.

2. Gastric cancer: The upper abdomen is mildly painful, and the abdominal mass is mostly in the upper abdomen near the pylorus, showing nodular shape. It can be differentiated from gastric torsion by X-ray signs or endoscopy.

3. Pyloric obstruction: a history of peptic ulcer, vomiting and eating, vomiting more, X-ray examination found pyloric obstruction, endoscopy examination of ulcers and pyloric obstruction.

4. Chronic cholecystitis: In the case of non-acute episodes, the patient presents with symptoms of pain in the upper abdomen and indigestion, which is induced by greasy food. The right quarter of the ribs have tenderness, radiating to the right shoulder, but no severe abdominal pain and nausea, retching. It can be inserted smoothly into the stomach tube, duodenal drainage and gallbladder angiography can have a positive finding.

5. Adhesive intestinal obstruction: The patient has a history of abdominal surgery, which is characterized by sudden paroxysmal abdominal pain, exhaust defecation is stopped, vomit has fecal odor, and the whole abdomen has pain; visible intestinal type, early bowel sounds The late is weakened. The stomach tube can be inserted smoothly, and the X-ray abdominal fluoroscopy shows a trapezoidal liquid level in the intestinal lumen.

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