Gastric volvulus obstruction symptoms

Introduction Stomach torsion, also known as the stomach reversal, the large curvature of the stomach and the small curvature of the stomach to lose the normal anatomical position of the rotation of the stomach itself, is a rare disease, accounting for about 2% of the stomach surgery. The gastric torsion may be that the large curvature of the stomach is turned up along the longitudinal axis of the stomach (organ axis), or the pyloric region may be reversed along the transverse axis of the stomach (the retina axis) to the cardia region, the degree of which may be different, clinically causing obstruction and Blood disorder. Stomach torsion is not common, its acute type develops rapidly, the diagnosis is not easy, and the treatment is often delayed. If the torsion exceeds 180°, acute upper abdominal pain and severe vomiting occur, requiring emergency surgery. The symptoms of chronic type are not typical and are not easy to find in time.

Cause

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.

an examination

Related inspection

Fiber endoscopy

Diagnosis: The severity of symptoms is related to the degree of torsion.

Infants within 1 year of age often have unexplained gastric torsion. Neonatal stomach torsion can occur after the birth of spitting milk or milk, but also a few weeks after giving birth. It happens more than a few minutes after feeding. After feeding, it is easier to spit milk when moving the child. There is a big mouth spit milk at the time of the attack. There is a milk flap in the vomit, but it does not contain bile. After vomiting, the appetite is good and I still want to eat milk. Malnutrition can occur in children with severe vomiting. Larger children with gastric torsion, mostly acute onset, clinical manifestations and acute abdomen are similar, severe pain in the upper abdomen, can be radiated to the left quarter rib, left chest and left back. These manifestations suggest that there is a gastric torsion, and the stomach tube can be inserted, and the stomach tube is often difficult to penetrate. Barium meal imaging can determine the diagnosis. More than 180° of torsion is often acute.

Acute gastric torsion in adults, sudden onset and rapid development, its clinical manifestations are similar to acute perforation of acute ulceration, acute pancreatitis, acute intestinal obstruction, etc., and acute gastric dilatation is sometimes difficult to identify. Typical performance is triad:

1 Sudden vomiting, then can not vomit the stomach contents, only hiccups or retching; often accompanied by frequent hernia, vomit does not contain bile. If the proximal stomach is obstructed, it is retching.

2 acute upper abdominal pain and fullness, the degree of pain is severe, and involved in the back.

3 The stomach tube cannot be completely inserted into the stomach. Physical examination showed swelling of the upper abdomen and flatness of the lower abdomen. Chronic gastric torsion has many properties, no obstruction, no obvious symptoms, or mild symptoms, similar to chronic diseases such as ulcer disease or chronic cholecystitis. Gastrointestinal barium meal examination is an important diagnostic method.

Differential diagnosis

Differential Diagnosis: Gastric torsion needs to be identified with the following diseases:

1. Acute stomach dilatation The abdominal pain is not serious, but the above abdominal distension is mainly 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. The main symptom of hiatal hernia is the burning or burning sensation of the sternum, accompanied by hernia or hiccup. This disease occurs mostly within 1 hour after a meal, and can produce symptoms such as shortness of breath, palpitations, and cough. But sometimes it can be combined with a stomach twist, X-ray barium meal test helps identify.

3. Myocardial infarction often occurs in elderly patients with severe arrhythmia. There are signs such as palpitations and angina before the onset. Characteristic ECG findings can be differentiated from gastric torsion.

4. Gastric cancer has mild pain in the upper abdomen, 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.

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

6. In the case of non-acute episodes of chronic cholecystitis, the patient presents with symptoms of pain in the upper abdomen and dyspepsia, 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.

But easy to relapse.

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