what causes stomach volvulus

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• Smoke. Smoking may increase the risk of peptic ulcers in people who are infected with H. pylori.
• Drink alcohol. Alcohol can irritate and erode the mucous lining of your stomach, and it increases the amount of stomach acid that's produced.
• Have untreated stress.
• Eat spicy foods.

What are the causes of gastric ulcer?

• Gastrin–cholecystokinin family: gastrin and cholecystokinin.
• Secretin family: secretin, glucagon, vasoactive intestinal peptide and gastric inhibitory peptide.
• Somatostatin family.
• Motilin family.
• Substance P.

What triggers the gastric phase of gastric secretion?

Signs And Symptoms Of Gastric Volvulus

• Sudden severe abdominal pain mainly located in the upper middle quadrant of the abdomen.
• Severe retching or unproductive vomiting.
• Difficulty in insertion of naso gastric tube.
• Distension of abdomen which over a period of time may become worse.
• Vomiting of blood.
• Uncontrolled hiccups.
• Sometimes there is sharp pain in chest which may radiate to left side of neck, shoulder, arm, and back.

What are the symptoms of a twisted stomach?

What Are Causes and Risk Factors for Upper Gastrointestinal Bleeding?

• Peptic ulcer disease: Peptic ulcers are localized erosions of the mucosal lining of the digestive tract. ...
• Gastritis: General inflammation of the stomach lining, which can result in bleeding in the stomach. ...
• Esophageal varices: Swelling of the veins of the esophagus or stomach usually resulting from liver disease. ...

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What are the causes of gastrointestinal bleeding?

How does gastric volvulus occur?

Primary gastric volvulus is thought to be due to laxity of the gastric ligaments. Secondary disease may occur due to a paraesophageal hernia or other diaphragmatic hernia. The presenting symptoms can be intermittent or complete gastric obstruction, ischemia, pain, and/or bleeding.

How serious is gastric volvulus?

Gastric volvulus is a rare entity with variable, nonspecific clinical presentations, which requires a high level of suspicion for radiologic diagnosis. Acute cases have a high mortality rate and require emergency surgery.

What are the symptoms of gastric volvulus?

Patients who present with chronic, intermittent, and vague signs and symptoms of upper abdominal pain, nausea, dysphagia, early satiety vomiting, and hiccups may have a chronic partial or intermittent gastric volvulus.

How do you fix a gastric volvulus?

In general, the treatment of an acute gastric volvulus remains emergency surgical repair. In patients who are not surgical candidates (secondary to comorbidities or an inability to tolerate anesthesia), endoscopic reduction may be attempted.

How common is stomach volvulus?

Gastric volvulus is rare. The incidence peaks after the fifth decade, with adults constituting 80 to 90 percent of cases [5]. No association with sex or race has been reported.

Is gastric volvulus an emergency?

Gastric volvulus is considered a medical emergency and, if not promptly recognized, can lead to life-threatening complications including gastric ischemia, necrosis, and perforation [15]. Because of otherwise rich blood supply, stomach strangulation is uncommon in only occurs in 5%–28% of patients [6].

Is a twisted stomach painful?

Patients with an acute gastric volvulus often present with upper abdominal pain and lower chest pain with associated retching. Retching can lead to mucosal tears. Patients often do not exhibit unstable vital signs or appear significantly distressed during the initial disease process.

Is a gastric volvulus a bowel obstruction?

Gastric volvulus is a rare clinical entity defined as an abnormal rotation of the stomach of more than 180°, which creates a closed-loop obstruction that can result in incarceration and strangulation. It can manifest either as an acute abdominal emergency or as a chronic intermittent problem.

What is chronic gastric volvulus?

Gastric volvulus is characterized by rotation of the stomach along its long or short axis leading to variable degrees of gastric outlet obstruction, which may present acutely or chronically. It can be primary (due to gastric ligaments) or secondary (due to anatomical abnormalities).

Why do babies have volvulus?

In children, volvulus occurs as a result of an abnormality in the rotation of the gut when the baby is still in utero. This occurs in babies about one in 6,000 live births. 7 

Where does volvulus occur?

The most common location for volvulus to occur in adults is the sigmoid colon and cecum. The stomach may also be affected. In children, the small intestine is usually the location of its occurrence. 4 

What is the surgical management of sigmoid volvulus?

Surgical management of a sigmoid volvulus includes resection of a portion of the bowel with either a reconnecting of the bowel or colostomy formation. 9  It depends on the extent of bowel injury to help determine which is the more appropriate approach. Usually, if the necrosis of the tissue is not extensive, there has been a great success in reconnecting the bowel in that same procedure without the need for a colostomy .

What is the mesentery of a sigmoid volvulus?

The mesentery is a fold in the peritoneum that helps to attach the intestines to the wall of the abdomen.

Why is volvulus dangerous?

Volvulus can be very dangerous because the twisting of the intestines may cut off blood supply causing extreme pain, discomfort, bloody stool, cramps, bloating, and obstruction of the bowel making it difficult to have a bowel movement, or necrosis of the bowel, ...

What is the best way to diagnose sigmoid volvulus?

Radiographs. Abdominal X-rays can help to make the diagnosis of sigmoid volvulus but usually need to be accompanied by other forms of imaging. (For children, an ultrasound can be performed initially to prevent radiation exposure.) The characteristic findings are distended large bowel and air-fluid levels.

What is the process of untwisting the intestines called?

The process of untwisting the intestines is called "reducing" the volvulus. In order to accomplish this, a flexible sigmoidoscopy is performed first. A sigmoidoscopy can reduce the sigmoid volvulus when it is advanced through the twisted segment of the colon. This allows it to unravel and the blood supply can be restored to the tissue.

Why does volvulus occur in infants?

In infants, volvulus of the small intestine often occurs due to malrotation. Malrotation occurs when a problem with the way the intestines form causes them to settle in the wrong place in the abdomen. This can cause the intestines to twist or become blocked.

Where does volvulus occur?

Volvulus of the small intestine usually occurs in infants and children. In adults, volvulus of the small intestine is rare. In adults, volvulus tends to occur in the colon and is known as a sigmoid volvulus.

What is volvulus in medicine?

Treatment. Complications. Outlook. A volvulus refers to abnormal twisting of a part of the large or small intestine. This twisting may lead to a bowel obstruction, which can cause severe complications. A volvulus is a medical emergency that requires prompt diagnosis and treatment.

Why does my sigmoid volvulus twist?

This can cause the intestines to twist or become blocked. In adults, causes of a sigmoid volvulus include: an enlarged colon. abdominal adhesions that develop after surgery, injury, or infection. diseases of the large intestine, such as Hirschsprung’s disease. a colon that is not attached to the abdominal wall.

How to correct a volvulus?

A volvulus needs prompt treatment and usually requires surgery. During surgery to correct a volvulus, a doctor will make a small incision in the abdominal wall near the site of the twisted part of the intestine and untwist it. Afterward, the doctor will restore blood flow to the areas affected by the volvulus.

What is a volvulus?

Share on Pinterest. A volvulus causes bowel obstructions, which may cut off the blood supply to areas of the bowels. A volvulus occurs when part of the colon or intestine twists. The twisting causes bowel obstructions that may cut off the blood supply to areas of the bowels. A volvulus is a medical emergency that needs surgical treatment.

What is the name of the disease that results from the lack of small intestines?

a severe infection of the blood called sepsis. a malabsorption disorder called short bowel syndrome, which results from the lack of small intestine. infection of the abdomen, known as secondary peritonitis. A volvulus can be life-threatening if not treated promptly.

What is gastric volvulus?

This condition is referred to as gastric volvulus or twisted stomach. The twisting of the stomach can occur in different planes. A twisted stomach adversely affects the movement of food through the stomach. It can also cause compression of nearby blood vessels, thereby choking blood supply to the stomach. The lack of blood supply can then lead to the death of the affected tissue areas in the stomach. Further serious complications include stomach tears.

What causes volvulus type 2?

The following are some of the potential causes of type II gastric volvulus: Defects in the diaphragm muscle may allow the stomach to move significantly. Gastric ligaments that hold the stomach in place may be lax.

What happens if gastric volvulus is not treated?

Potentially lethal complications may arise if gastric volvulus is not treated promptly. The following are some of the potential complications: Necrosis of the stomach tissue can occur if the blood supply to the stomach ceases due to compression of the blood vessels that supply the stomach.

How to classify gastric volvulus?

Cases of gastric volvulus can be classified in two ways. One way is to classify gastric volvulus based on the axis around with the stomach twists. Another way is to classify gastric volvulus based on the underlying cause. Organoaxial type: About 60% of the cases of gastric volvulus are of the organoaxial type.

What type of volvulus is about 30%?

Mesenteroaxial type: About 30% of the cases of gastric volvulus are of the mesenteroaxial type.

What are the three types of volvulus?

Gastric volvulus can be classified into the following three categories based on the type of stomach twists involved: Organoaxial type: About 60% of the cases of gastric volvulus are of the organoaxial type. Mesenteroaxial type: About 30% of the cases of gastric volvulus are of the mesentero axial type. Combined type: Cases with combined type of ...

How many cases of volvulus are there in children?

Only about 10-20% of the cases of gastric volvulus are in children. The cause of gastric volvulus is not clear in most cases. However, different factors that allow an increased movement of the stomach are associated with the condition. In the absence of surgical treatment, gastric volvulus has a high mortality rate (about 80%).

What is gastric volvulus?

Gastric volvulus is also known commonly as a twisted stomach. It is a rare condition where the stomach rotates abnormally more than 180 º. The twisting can occur on different planes. Apart from affecting normal movement through the stomach, a gastric volvulus can also cause the blood vessels supplying the stomach to become compressed. This can cut off the flow off blood and lead to a tissue death of the affected area of the stomach wall which in turn can progress to serious complications. Sometimes the stomach may tear.

Which type of gastric volvulus accounts for 30% of all cases of gastric volvulus?

Mesentroaxial type which accounts for about 30% of all cases of gastric volvulus.

What type of volvulus is most common?

As discussed previously, type 1 gastric volvulus is the most common but occurs for unknown reasons (idiopathic). The stomach is held in position by several ligaments (gastrosplenic, gastroduodenal, gastrophrenic, and gastrohepatic ligaments). These ligaments have to maintain a certain degree of flexibility but also has to be relatively taut ...

What is a stomach vulvulus?

Gastric Volvulus (Twisted Stomach) Causes, Symptoms, Treatment. As with all organs in the body, the stomach has a set orientation. Most of the abdominal organs, especially the different parts of the digestive tract, have some degree of mobility. However, these minor changes in position are limited and usually does not change the orientation ...

How to treat a twisted stomach?

Treatment for a Twisted Stomach. A gastric volvulus may be acute or chronic. Emergency surgery is necessary for an acute gastric volvulus. Surgery is also needed in chronic cases but it is usually done to prevent complications .

How many cases of volvulus are there in children?

About 10% to 20% of cases occur in children and gastric volvulus mainly arises before the age of 50 years. It affects both males and females equally. The cause of most cases of gastric volvulus is not known but it is associated with factors that allow for increased motion of the stomach from its normal position.

What are the different types of volvulus?

Types of Gastric Volvulus. A gastric volvulus may be classified according to the way in which the stomach twists (the axis around which it twists) or by the cause of the volvulus. The first classification includes: Organoaxial type which accounts for almost 60% of all cases of gastric volvulus. Mesentroaxial type which accounts for about 30% ...

Where is the primary gastric volvulus?

Primary gastric volvulus occurs below the diaphragm and is found in a third of cases. Secondary gastric volvulus occurs above the diaphragm and is associated with a defect in the diaphragm or a herniation of the stomach upwards towards the esophagus.

What is the presentation of acute gastric volvulus?

The presentation of acute gastric volvulus includes sudden severe pain in the upper abdomen or lower chest and persistent but unproductive vomiting. Because the volvulus causes gastric obstruction, it is often impossible to pass a nasogastric tube into the stomach. This combination of pain, unproductive vomiting, and inability to pass a nasogastric tube is termed Borchardt's triad. The differential diagnosis includes myocardial infarction, biliary obstruction, and acute pancreatitis. Physical examination may reveal evidence that the stomach is in the left chest. A large gas-filled structure may be seen in the chest on X ray. A barium upper gastrointestinal X ray or computerized tomography with oral contrast will confirm the diagnosis. If upper endoscopy is performed, it may show twisting of the gastric folds, but endoscopy is not prudent if gastric ischemia is suspected.

How is volvulus managed?

Any persistent twisting is reduced, and associated defects are repaired. Concomitant gastric perforations are often closed, around a feeding gastrostomy if possible. Chronic primary gastric volvulus is treated nonoperatively in many countries with prone or right lateral positioning of infants after feeding, but therapy in the majority of cases in the United States is surgical, with gastric fixation by gastropexy or gastrostomy tube placement.

How old is the average gastric volvulus?

The average age at presentation is 2.5 years. Equal numbers of males and females are affected. 52 Gastric volvulus is classified into categories based on the axis of gastric rotation. Mesenteroaxial gastric volvulus is rotation about the gastric short axis, transecting the greater and lesser curvatures. Organoaxial gastric volvulus is rotation around the long axis of the stomach ( Figs. 30-12 and 30-13 ).

What is the name of the pouch that rotates the stomach?

Gastric volvulus develops when the prolapsed larger proximal pouch is filled with a large volume of food and rotates the stomach along its long axis at the level of the gastric band with fixed distal gastric pouch resulting in closed-loop obstruction.

What is the stomach on a radiograph of the chest?

AP radiograph of the chest shows the stomach in the midline above the diaphragm consistent with hiatal hernia , most having volvulus.

When is peak incidence of gastric volvulus?

Peak incidence is in the fifth decade of life. Pain, violent retching, and inability to pass a nasogastric tube is very suggestive of acute gastric volvulus.

Where does gastric volvulus come from?

It comes into your thorax through a weakness or tear in your diaphragm. Gastric volvulus is also more commonly found in people who have birth defects, also known as congenital abnormalities, of their diaphragm.

How does gastric volvulus come into the thorax?

It comes into your thorax through a weakness or tear in your diaphragm. Gastric volvulus is also more commonly found in people who have birth defects, also known as congenital abnormalities, of their diaphragm. It can also be caused by: Gastric, or stomach, ligaments that are too long.

What is the procedure to repair a gastric volvulus called?

The surgery to repair gastric volvulus is called anterior gastropexy and is considered an emergency surgery. After surgery you will be in the hospital for a couple of days before you are discharged to make sure that the surgery fixed the problems and there are no complications from the surgery.

How to repair volvulus?

When you have surgery for acute gastric volvulus it is done to repair the problem by untwisting your stomach and fixing it into place so this does not happen again. If there is any presence of gangrene during the surgery that tissue is also removed. Before your stomach can be fixed to the diaphragm and anterior abdominal wall it will have to be tested for viability, which means they need to make sure that it has not turned gangrene and will still function the way the stomach should function. The surgery to repair gastric volvulus is called anterior gastropexy and is considered an emergency surgery. After surgery you will be in the hospital for a couple of days before you are discharged to make sure that the surgery fixed the problems and there are no complications from the surgery.

What percentage of volvulus is mesenteroaxial?

Approximately twenty-nine percent of the cases of gastric volvulus are mesenteroaxial type. Combined type – this is a rare form in which the stomach twists organoaxially and mesentericoaxially.

What is the name of the type of stomach revolving?

Organoaxial gastric volvulus – this type involves your stomach revolving along its length and more frequently associated with the blood supply being cut off to your stomach. Fifty-nine percent of all cases of gastric volvulus are this type. Mesenteroaxial gastric volvulus – this type occurs when your stomach flips upside down with the back ...

How long does it take to recover from gastric volvulus surgery?

Surgery Recovery time. If you have had open surgery to fix your case of gastric volvulus it can take two to six weeks before you are fully recovered. During this time you should not be putting this area under a lot of stress and stretches and taking it easy. Gastric Volvulus. 4.7 (94.18%) 55 votes.

Why do people with volvulus lose appetite?

Lack of appetite: Those with volvulus tend to lose their desire to eat due to their abdominal symptoms.

Where does volvulus develop?

Volvulus can develop in any portion of the large bowel, with the sigmoid colon being the most common and being due to mesenteric anatomy—the soft tissue that attaches the intestines to the wall of the abdomen. Having a long mesentery with a narrow base of fixation may predispose a person to developing a twisted bowel.

What are the symptoms of twisted bowels?

Serious causes of twisted bowel result in intestinal strangulation, and if left untreated can lead to entire segments of the intestinal tract to die off.

How successful is sigmoid volvulus surgery?

This procedure is successful in more than 90 percent of patients with sigmoid volvulus, but only 10 to 15 percent successful in those with fecal volvulus. Serious cases of volvulus will require surgery and are considered the best option for treating and preventing the possibility of bowel strangulation.

What is the name of the small bowel?

It may be referred to as small bowel volvulus or colonic volvulus respectively. Where the twist and obstruction are located will dictate the presentation of the condition. In humans, the bowels consist of the small and large intestine. The small intestine is further divided into the jejunum, duodenum, and ileum, ...

Why does my intestine twist?

Intestinal malrotation: Due to an existing problem of the bowel that hasn’t shaped properly or doesn’t align accurately with the abdomen.

What happens if your bowel is twisted?

The most worrisome issue with a twisted bowel is that if the abnormality is not fixed in time, necrosis or cell death will occur due to the obstruction of blood flow to the area. In the western world, the incidence of small bowel volvulus occurs in about 1.7 to 6.2 percent of adults. It may be the result of a primary cause occurring in ...

What Are The Causes Of Gastric Volvulus?

Gastric Volvulus or Stomach Volvulus is basically of two types, Type 1 which is also called as Idiopathic Gastric Volvulus and Type 2 which is knows as Congenital or Acquired Gastric Volvulus.

What is stomach volvulus?

Gastric Volvulus or Stomach Volvulus is a rare medical condition in which there is abnormal rotation of stomach at an angle of more than 180 degrees thus creating an obstruction which is in the form of a closed loop which can cause intestinal strangulation. The classic presenting feature of Gastric Volvulus or Volvulus of Stomach is severe ...

How Is Gastric Volvulus Diagnosed?

If a detailed physical examination is conducted for confirming Gastric Volvulus in an individual, it may reveal inconclusive results as there are many more conditions which mimic the symptoms produced by Gastric Volvulus hence more invasive studies in the form of radiographic studies, imaging, and upper GI series are done for a more confirmatory diagnosis of Gastric Volvulus. Imaging in the form of CT scan usually confirms the presence of Gastric Volvulus. An endoscopy may also confirm the diagnosis of Gastric Volvulus. If a chest x-ray is taken it will show gas-filled viscus which also confirms diagnosis of Gastric Volvulus or Volvulus of Stomach. Abdominal radiographs will reveal massively distended viscus in upper abdomen. Another way to confirm the presence of Gastric Volvulus is to conduct an Upper GI series. This is done using barium and virtually confirms the presence of Gastric Volvulus.

What Is The Normal Diet To Be Followed After Surgery For Gastric Volvulus?

Patient after abdominal or chest surgery may not be able to eat normal diet for several days. Surgery on gastrointestinal system may be followed nothing by mouth for 10 to 15 days. In all other surgery the oral intake or oral diet initiation depends on type of anesthesia given to patient. Surgery is performed either under general, regional or local anesthesia. The general anesthesia often causes nausea and vomiting for 24 to 48 hrs. In such cases liquid diet is preferred for 1 to 2 days after surgery. The deep or light sedation is given when surgery is performed under regional anesthesia like spinal, epidural or nerve block. Sedation like general anesthesia may cause nausea and vomiting for 24 hours. Brain surgery, surgery of mouth and oral cavity also delays the oral feeding or intake of food by mouth. In short the time of initiation of oral feeding depends on type of surgery and anesthesia.

What is the name of the GI condition that causes retching and pain in the stomach?

Acute Gastric Volvulus: The classic feature of this type of Gastric Volvulus is severe abdominal pain, retching with difficulty in passing an NG tube in the stomach. This is present in about 75% of cases of Gastric Volvulus. Studies have also shown presence of gas-filled viscus in lower chest or upper abdomen on chest x-rays and obstruction noted on upper GI series. Also noted in such cases have been severe hiccups. Intraabdominal Gastric Volvulus commonly presents itself as sudden onset severe epigastric or left upper quadrant pain. Intrathoracic gastric volvulus presents itself as a sharp chest pain going towards the left side of neck, shoulder, arms, and back. In some cases there may be observation of hematemesis which is quite serious and can quickly progress to hypovolemic shock.

How to treat gastric volvulus?

The surgical procedure to treat Gastric Volvulus is done using the laparoscopic approach. Some of the conditions which may make a patient a poor candidate for surgical repair is intolerance of anesthesia.

Does Volvulus need water?

Avoiding constipation is also necessary in Volvulus and constipation may occur especially if there is reduced fiber intake. Thus, it is recommended that the individual consume plenty of water to avoid cons tipation.

What is gastric volvulus?

Gastric volvulus is defined as an abnormal rotation of the stomach beyond 180 degrees.1-3It is a rare clinical condition, and because many chronic cases are never diagnosed its precise incidence is unknown. The first case was reported by Berti in 1866, and the first surgical intervention was performed by Berg in 1895.3,4The clinical presentation is variable and may range from an acute abdomen necessitating emergency surgery to chronic, nonspecific abdominal complaints. The classic symptoms, known as “Borchardt’s triad,” consist of nonproductive vomiting, severe and constant epigastric pain, and difficulty inserting a nasogastric tube; however, they may not be present in as many as 25% of patients.5There are no predilections for a particular gender or race; however, most cases occur in middle-aged patients, and up to 75% are associated with a paraesophageal hiatal hernia, abdominal adhesions, or other diaphragmatic or intraabdominal conditions.3

What are the different types of volvulus?

There are four subgroups of gastric volvulus according to the axis of rotation. In type 1 , or organoaxial rotation, the stomach rotates around the pylorus-cardia axis. This is the most common type, comprising approximately 60% of cases, and may lead to obstruction at the gastroesophageal junction, the pylorus, or both—or even strangulation and vascular compromise. In type 2, or mesenteroaxial rotation, the stomach rotates around the lesser–greater curvature axis. The most important risk factor in this type is laxity of the gastrosplenic ligament. Type 3 is a combined form and is the least common, accounting for only 2% of cases. Type 4 is “unclassified” and accounts for approximately 10% of cases.5

What is the gross appearance of the stomach?

Gross appearance of the stomach. A -Extensive gastric mucosal necrosis of gastric body/fundus with ulcerations; B -Formalin-fixed stomach with a sharp line of demarcation showing the sparing of the antral/pyloric mucosa .

Can a CT scan show gastric volvulus?

The most difficult aspect of diagnosing gastric volvulus is the consideration of it.5Imaging studies with barium or CT scans can aid in the diagnosis; however, the findings may be subtle and easily overlooked if volvulus is not in part of the differential diagnosis.2,5After an intraoperative diagnosis of gastric volvulus, a review of the imaging studies will occasionally show that findings typical of volvulus had been present, and that a preoperative diagnosis was not made because this entity was not considered.5While our patient’s prior imaging studies showed only a hiatal hernia, most cases of volvulus are associated with this condition. While rare, gastric volvulus should be considered in patients with a history of hiatal hernia or other diaphragmatic defects that present with or develop acute abdominal symptoms. A postmortem review of imaging studies performed at the time of admission revealed evidence of gastric volvulus (Figure 7), but as is often the case, these subtle findings were not initially appreciated.

Where are gastric contents found?

Gastric contents were found within the trachea extending into the most distal branches of the bronchial tree (Figure 4). Microscopically, there were bilateral and diffuse intrabronchial and intraalveolar food particles consistent with bronchoaspiration (Figure 5).

Is gastric volvulus a rare disease?

Gastric volvulus is a rare entity with a high mortality rate when presenting acutely. Therefore, it should be considered in the differential diagnosis in patients presenting with acute abdominal symptoms, particularly when there is a medical history of hiatal hernia or other diaphragmatic defects.1-5This case highlights the value of autopsy in the diagnosis of unsuspected cases of gastric volvulus when death occurs prior to surgical intervention. Without an autopsy, the underlying cause of death in this patient would not have been diagnosed.

Mechanism

Clinical significance

• The cause of volvulus is not entirely known. It predominately occurs in older adults around age 70. Some studies have shown it to be more common in men, though other studies have found no link to gender.5 It is more common among those who are debilitated with neurologic or psychiatric conditions with associated constipation. Where the cause is not...

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Epidemiology

Classification

Causes

Signs and symptoms

• Gastric volvulus is also known commonly as a twisted stomach. It is a rare condition where the stomach rotates abnormally more than 180º. The twisting can occur on different planes. Apart from affecting normal movement through the stomach, a gastric volvulus can also cause the blood vessels supplying the stomach to become compressed. This can cut o...

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Diagnosis

Prognosis

Treatment