Gastroptosis

　　Gastric volvulus can be divided into two major types based on the mode of torsion:

　　1. Rotational Gastric Volvulus around the Longitudinal Axis or Organ Axis Type:The greater curvature of the stomach rotates upwards around the longitudinal axis of the stomach, resulting in the greater curvature upwards and the lesser curvature downwards, producing an inverted stomach. Depending on whether the twisted stomach is above or below the colon, it can be divided into supracolic and infracolic types, with the former being more common.

　　2. Rotational Gastric Volvulus around the Transverse Axis or Mesenteric Axis Type:The stomach rotates around the transverse axis of the stomach, which is the longitudinal axis of the lesser omentum, from right to left or from left to right. In the former, the antrum is located in front of the corpus, while in the latter, the corpus is in front of the antrum. Apart from the part attached to the diaphragm, the entire stomach rotates, which is a complete volvulus. Only a partial volvulus occurs in some patients, usually involving the antrum. Torsion exceeding 180 degrees is acute gastric volvulus. Torsion less than 180 degrees is chronic gastric volvulus.

　　Gastric volvulus is rare and can be primary or secondary. The most important pathogenic factor for the primary type is congenital relaxation and elongation of the gastric ligaments, or the transection of the gastro-hepatic, gastro-splenic, and gastro-colonic ligaments. Abnormal gastric motility, heavy traction of the overloaded stomach, acute gastric dilatation, overeating, severe vomiting, and increased intra-abdominal pressure can all induce gastric volvulus. Secondary gastric volvulus is most common in diaphragmatic hernia, diaphragmatic emphysema, and postoperative diaphragmatic muscle relaxation after cervical vagotomy, which may be related to the long-term traction of the chest cavity negative pressure that relaxes the gastro-splenic ligament. Gastric volvulus can also occur in gastric tumors, colon distension, enlarged spleen compressing the stomach, and upper abdominal incisional hernia. Partial gastric volvulus is more common in hourglass stomach.

　　The clinical symptoms of gastric volvulus depend on its acuteness, chronicity, the extent and degree of torsion. Its acute type develops rapidly, is difficult to diagnose, often delayed in treatment, while the symptoms of the chronic type are atypical and not easily detected.

　　Congenital gastric volvulus in newborns is a congenital malformation that may be related to malrotation of the small intestine, leading to poor fixation of the gastro-splenic ligament or gastro-colonic ligament due to relaxation. Most can be corrected spontaneously with the growth and development of the infant.

　　1. Acute Gastric Volvulus:In the late stage, vessel occlusion, necrotic perforation of the gastric wall, severe gastrointestinal bleeding, even shock, and death may occur. The mortality rate can be as high as 30% to 50%.

　　2. Chronic gastric volvulus:A small number of patients may have upper gastrointestinal bleeding due to mucosal injury at the site of torsion or intrinsic gastric lesions.

　　The clinical symptoms of gastric volvulus depend on its acuteness, chronicity, the extent and degree of torsion.

　　1. Acute Gastric Volvulus:The onset is acute, characterized by pain in the upper abdomen or left chest, with significant distension of the upper abdomen and a flat and soft lower abdomen in patients with diaphragmatic gastric volvulus. In patients with supradiaphragmatic gastric volvulus, chest symptoms may occur while the upper abdomen may be normal, with chest pain that can radiate to the arm and neck, accompanied by difficulty breathing, hence often misdiagnosed as myocardial infarction. Acute gastric volvulus patients often have persistent dry heaves with very little vomiting, and bleeding is rare. If bleeding occurs, it often indicates mucosal ischemia or esophageal rupture. The characteristic triad of acute gastric volvulus includes:

　　(1) Persistent dry heaves, rarely or without vomiting.

　　(2) Sudden, severe, and short-term chest or upper abdominal pain.

　　(3) It is difficult to insert a gastric tube into the stomach.

　　2. Chronic gastric volvulus:Patients with chronic gastric volvulus often have non-specific symptoms such as discomfort in the stomach, indigestion, burning sensation, upper abdominal fullness or borborygmi, which are more likely to occur after meals. Although patients rarely have symptoms of gastroesophageal reflux, endoscopic examination often reveals esophagitis. The pain of intermittent gastric volvulus is similar to that of acute gastric volvulus, but less severe. Because of its transient characteristics, it is often misdiagnosed as originating from the pancreas and bile duct. For patients with esophageal paraesophageal hernia who have intermittent upper abdominal pain, especially those accompanied by vomiting or dry heaves, chronic intermittent gastric volvulus should be considered.

　　Gastric volvulus is not uncommon in clinical practice and can occur at any age, with acute and chronic types. Chronic gastric volvulus is more common in middle-aged and older men, with atypical clinical symptoms, irregular, and can persist or intermittent. Early detection of anatomical and pathological abnormalities that can cause gastric volvulus, and eliminating such causes, paying attention to precipitating factors that can cause the disease, early detection and early treatment are important.

　　The following are the laboratory tests that gastric volvulus patients need to do:

　　1. X-ray examination:Standing position chest and abdominal X-ray film can see two liquid-gas levels, one located near the proximal stomach below the left half of the diaphragm, and the other located in the distal stomach in the posterior mediastinum behind the heart. If pneumoperitoneum occurs, it indicates concurrent gastric perforation.

　　2. Upper gastrointestinal barium meal examination:Patients with mesenteric axis volvulus can be seen that the connection between the esophagus and the stomach is at an abnormally low position below the diaphragm, while the distal stomach is located at the side of the head, the body of the stomach, and the antrum overlap, and the cardia and pylorus can be at the same level. Organ axis volvulus can be seen with the stomach upside down, the large curvature of the stomach above the small curvature, the liquid level of the stomach bottom not connected with the body of the stomach, the body of the stomach deformed, the pylorus downward, and the gastric mucosal folds can be twisted. Esophageal obstruction at the lower end is presented as a pointed shadow.

　　3. Endoscopic examination:Endoscopic examination during gastric volvulus is somewhat difficult, and it can be seen that the anterior and posterior walls of the stomach or the large and small curvatures of the stomach have changed. Some patients may find esophagitis, tumor, or ulcer.

　　Gastric volvulus refers to the change in the position of the upper and lower curvature of the stomach, that is, the large curvature is above and the small curvature is below, which is called gastric volvulus. Patients with gastric volvulus should pay attention to their lifestyle, which can reduce the probability of onset and the severity of symptoms.

　　Regular diet:Eating regularly and at fixed times can form a conditioned reflex, which is helpful for the secretion of digestive glands and more conducive to digestion.

　　Regular and fixed meal times:It is necessary to have a moderate amount of food at each meal, and to have meals at a fixed time each day. When the specified time comes, no matter how hungry or not, one should actively eat to avoid being too hungry or too full.

　　Eat less fried food:Because this kind of food is not easy to digest, it will increase the burden on the digestive tract, eating too much will cause indigestion, and it will also increase blood lipids, which is not good for health.

　　Eat less preserved foods:These foods contain a lot of salt and certain carcinogens, and should not be eaten in large quantities.

　　Eat less cold and spicy foods:Cold and spicy foods have a strong stimulating effect on the mucosa of the digestive tract, which is easy to cause diarrhea or gastrointestinal inflammation.

　　Acute gastric volvulus must be treated surgically; otherwise, the blood circulation of the gastric wall may be obstructed and necrosis may occur. If the gastric tube can be successfully inserted and the gas and fluid in the stomach can be aspirated, surgery can be considered after the acute symptoms are relieved and further examination is performed.

　　When opening the abdominal cavity, what is mostly seen first is the tense posterior wall of the transverse mesocolon. Due to the disorder of anatomical relationships and the expanded gastric wall, surgeons often find it difficult to recognize the condition of the lesion. At this time, it is advisable to puncture the gastric wall to exhaust the accumulated air and fluid in the stomach, suture the puncture site, and then proceed with exploration.

　　After the stomach body is reset, according to the pathological changes found, such as diaphragmatic hernia, esophageal hiatus hernia, tumor, adhesion, etc., excision or repair should be performed. If the related etiology and pathological mechanism cannot be found, gastric fixation can be performed, that is, the stomach cecocolic ligament and stomach splenic ligament from the lower pole of the spleen to the gastroesophageal orifice are densely sutured to the anterior abdominal wall peritoneum to prevent recurrence of volvulus.

　　For those with partial gastric volvulus accompanied by ulcers or gourd-shaped stomach and other lesions, partial gastrectomy can be performed, and etiological treatment is extremely important. Attention should be paid to correcting water and electrolyte imbalances before surgery. After surgery, continuous gastrointestinal decompression should be performed for several days.

　　Due to the lack of specific differential symptoms of gastric volvulus and other stomach diseases, clinical physicians rarely consider this disease. The diagnosis is made by observing changes in the gastric shape under gastroscopy, such as the longitudinal folds on the greater curvature being above and the lesser curvature being below, the anterior and posterior positions of the stomach being reversed, the shape of the stomach changing or disappearing, and the distal pylorus being invisible, etc., indicating that gastric volvulus has occurred. In the past, diagnosis was often made by X-ray barium meal examination. In recent years, with the widespread application of gastroscopy and the continuous improvement of the diagnostic level of operators, this disease has gradually been recognized and discovered, and gastroscopy has become the main means of diagnosis and treatment. Gastroscopic reduction method: After passing through the esophageal orifice, the gastroscopy first inflates the gastric cavity to expand it, then enters the cavity along the cavity to determine the type, location, direction, and degree of gastric volvulus, and adopts different methods of reduction according to the type of gastric volvulus.