home Consultations Causes of gastric torsion in dogs. How serious is the expansion of the stomach and volvulus? What can be confused with this condition

Causes of gastric torsion in dogs. How serious is the expansion of the stomach and volvulus? What can be confused with this condition

Gastric torsion in dogs is a fairly common problem that always occurs unexpectedly and can lead to death in a matter of hours. Yesterday a healthy and cheerful animal, and a day later, an operating room, and a disappointing diagnosis. Today we will tell you about the causes, symptoms, treatment and surgery to correct gastric volvulus in dogs.

This disease develops against the background of seemingly ordinary flatulence. But as a result of the accumulation of gases, there is a displacement and twisting of the stomach. With many associated complications. The disease proceeds at lightning speed, within 4-12 hours the condition worsens even without qualified assistance death inevitable. On the picture X-ray miniature pinscher, a boy with gastric volvulus:

It is very difficult to isolate one or more exact causes of gastric volvulus in dogs, but systematizing the data, it is possible to identify risk factors that contribute to the development of the disease.

It is more common in large and giant breeds, but gastric volvulus can occur in any dog, without exception.
Disposing factors also include weakness of the ligaments that hold the stomach, hereditary predisposition, chronic diseases bodies digestive system and features of the structure of the chest. Namely, the ratio of its width (distance between the ribs) and depth (distance from the lowest point of the sternum to the withers), when the indicator is above 1.4, the animal is at risk. Improper maintenance and feeding most often gives a direct impetus to the development of the disease.
The presence in the diet of heavy, low-grade, bulky foods that cause bloating can provoke gastric volvulus in dogs.
Large portions and voracious eating of food happens when a dog is fed once a day.

In addition to the above reasons, accumulation in the stomach can provoke a volvulus. large mass indigestible items that do not pass into the dog's intestines. These items often include uncrushed bones, toy parts, and small stones.

In addition, the causes of the development of this pathology can be genetically determined.

Symptoms

Next, we will analyze in detail external symptoms torsion of the stomach in a dog. The accumulation of gases leads to the expansion of the stomach. The next step is directly its displacement and twisting, which entails the displacement of the spleen, squeezing the nerves and vital vessels. Violated innervation and blood circulation throughout the body. Blood stasis leads to respiratory failure, the amount of toxins increases, the work of the heart is disturbed, state of shock and death.

For as yet undetermined reasons, most often, volvulus occurs at night. Symptoms of gastric torsion in dogs include:

Volume increase abdominal wall and its pain on palpation.
The animal behaves restlessly, breathing is frequent and shallow.
Profuse salivation, constant urge to vomit.
The gums become pale, sometimes there is a loss of consciousness.

The first thing the owner should do, even if there are “blurred” symptoms, is to give no-shpu or analgin and urgently take him to the clinic.

Diagnostic methods

An accurate diagnosis can only be made in a veterinary clinic. A diagnostic laparoscopy prescribed by a veterinarian can absolutely confirm or remove the suspicion of gastric volvulus. You can temporarily relieve the animal's pain by inserting a special probe into the stomach, through which gases filling the stomach will escape. However, gases after a while accumulate again, and the procedure has to be repeated. All this confirms the obstruction of the stomach.

Treatment

Inversion of the stomach in dogs is treated in the following way. After the animal is delivered to the clinic, a presumptive diagnosis is made based on the symptoms and an X-ray examination is prescribed. Usually x-ray abdominal cavity enough to confirm the diagnosis, since the picture in the picture is very specific. Sometimes, gastric probing is additionally performed. Some doctors use ultrasound to confirm the diagnosis. Treatment of gastric volvulus in a dog always involves surgery - surgery. And the sooner the diagnosis is made and the operation is performed, the higher the chances of recovery.

Surgery and post-operative care

Immediately after the diagnosis is clarified, the animal enters the operating table. Sometimes, before surgery, a puncture is made in the peritoneum to remove air and reduce pressure on the walls of the stomach. Measures are being taken to stabilize the situation. During the operation, the surgeon makes an incision on the abdominal wall, returns the stomach to its natural position and fixes it using a special technology that helps prevent stomach torsion in dogs in the future. After that, the stomach is emptied by means of a probe and washed out.

It happens that part of the wall of the stomach, and sometimes the spleen dies, then you have to resort to their removal. IN final stage operation, the entire abdominal cavity is washed with an antiseptic, examined for bleeding, and if there are none, the wound is sutured.

Postoperative monitoring of sick dogs with gastric volvulus is carried out in accordance with general rules postoperative management of animals. To begin with, with the help of laboratory and ultrasound research, reveal all violations of gastric activity and treat or eliminate them.

The severity of the postoperative course of the disease will depend on the severity of the operated pathology, the presence of complications and concomitant diseases and the age of the animal. After all, it is known that puppies and strong young dogs recover and recover faster than older animals. The condition of the dog can stabilize and return to normal already a day after the operation. IN severe cases this will take up to 4-5 days. Usually the pet stays in the hospital for 2-3 days.

After the operation, the animal is on a starvation diet for 1-2 days, the suture is processed daily. The surgical wound is under a bandage. Additionally, antibiotics, supportive and antiemetic drugs are prescribed. The stitches are usually removed after two weeks.

What can be confused with gastric torsion

Acute dilatation of the stomach is a volvulus-like condition. Only with it, the stomach does not twist, but only swells from the accumulation of gases. All symptoms can point to gastric volvulus - in a restless dog painful stomach suddenly increases in size.

being treated this pathology with the help of a probe inserted into the stomach and the waste of accumulated gases through it. Sometimes a puncture of the stomach is required: it is pierced with a sharp needle through which gases are released. After the procedure, the animal immediately feels relief.

Prevention

The basis preventive measures with gastric torsion in dogs - proper feeding and a balanced diet.

Food should be of high quality, easily digestible, warm.
It is important to break the daily portion into several doses.
After and before feeding, you need to limit physical activity.
Dogs prone to pathology are sometimes operated on as a preventive measure. It is called a gastropexy and involves fixing the stomach to prevent volvulus.

The outcome of the disease always depends on correct diagnosis and timely treatment.

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Gastric dilatation and volvulus is a life-threatening disorder that usually occurs in large dogs. On early stage the stomach fills with gas, causing it to expand or swell. In some cases, the disorder does not progress further than the expansion of the stomach.

What causes stomach expansion?

The exact cause of the development of the disorder is still unknown. The condition is most commonly seen in large breed dogs that eat and drink quickly and then exercise vigorously.

Stress may also be a contributing factor to stomach expansion - studies show that dogs that were more relaxed and calm were less at risk of developing the disorder.

How serious is the expansion of the stomach and volvulus?

Very seriously, this is probably one of the most dangerous non-traumatic diseases of dogs. Immediate veterinary attention is required to save the dog's life.

Which dogs are more likely to develop gastric dilatation?

According to statistics, large, with deep breasted dog breeds. These breeds are the St. Bernard, Irish Setter, Weimaraner, Gordon Setter, Poodle, Doberman and Bobtail. It should be noted that bloating and stomach expansion can occur in any dog, even the Dachshund or Chihuahua. The condition usually occurs two to three hours after eating a large amount of food.

Some facts about gastric dilatation and volvulus:

Dogs weighing over 40 kg have an approximately 20% risk of developing the condition.
Dilatation of the stomach without volvulus sometimes occurs in older small dogs.
Bloating presses on the diaphragm and can make it difficult to breathe.
Expansion of the stomach can put pressure on large blood vessels in the abdominal cavity and severely disrupt blood circulation, which in itself can be fatal.
Eventually, the dog faints and the bloating becomes evident when the dog is lying on its side.

Factors that increase the risk of stomach dilatation:

Feeding only once a day
Hereditary medical history
Quick meal
Low or underweight with a skinny build
Anxious or nervous character
Aggressiveness towards people or other animals
Males are more prone to bloating than females
Adult and older dogs (7-12 years old) are at higher risk

Factors that reduce the risk of stomach expansion:

Feeding two or more times a day
Adding canned food to food
Calm and relaxed character
Feeding dry food containing rich in calcium meat (e.g. lamb meat, fish, bone meal)

It is worth noting that gastric dilatation and volvulus cannot be distinguished, as they look the same and have the same symptoms. An x-ray is often required to diagnose a volvulus.

Why does a dog faint?

The expansion of the stomach presses on the large veins that carry blood back to the heart, disrupting circulation. Vital tissues and organs are deprived of oxygen, causing tissues to begin to die. Digestion stops and toxins begin to accumulate in the blood. If the expansion continues, it can lead to rupture of the stomach.

What can be done?

This life threatening emergency requires urgent veterinary care.

It is necessary to reduce the pressure on the walls of the stomach and internal organs as soon as possible. The veterinarian may use a stomach tube first. If this is not possible due to gastric torsion, a needle may be inserted through the skin. big size to reduce pressure in the stomach.

Shock therapy should also be given as quickly as possible, with intravenous injections medicines. After the dog's condition is stabilized, it can be performed surgical correction inversion.

What is the prognosis and survival rate?

The prognosis depends on the duration and severity of the condition, the degree of shock, heart problems, necrosis of the stomach wall, etc.

Even in relatively uncomplicated cases, the mortality from volvulus is 15-20%. In the case of severe tissue damage, when part of the stomach needs to be removed, the mortality rate increases to 38%. If removal of the spleen is required, the mortality also increases to 38%.

Can stomach expansion be prevented?

Gastropexy (surgical fixation of the stomach) is the most effective remedy prevention. In high-risk breeds, some veterinarians recommend prophylactic (preventative) gastropexy.

This does not prevent expansion (bloating), but it does prevent twisting (torsion) in most cases. Without gastropexy, the recurrence rate increases by more than 75%!

Paying close attention to your dog's diet, feeding, and exercise program can help prevent stomach expansion.

In childhood, we all often heard: “Don’t jump a lot, don’t run and don’t somersault. Otherwise, you will get a volvulus of the stomach. Then it seemed just ridiculous parental prohibitions. In fact, this disease is not at all comical, and not invented, but very serious. Its consequences can give not only complications for life, but also lead to death.

What is volvulus?

Turning to medical literature, we will see that the volvulus of the stomach (popularly - the volvulus of the intestines) is a failure of the patency of any part or segment of the intestine. Most of the rest of this disease are affected areas small intestine. Torsion of the stomach occurs when a section of the intestine forms a loop, together with the mesentery or around it.

Disease prevalence

Gastric volvulus is rare, but is considered serious illness. Women and men aged 40-50 are equally prone to it. However, lovers of vegetarian food are mostly susceptible to this disease. It is easy to explain such statistics: vegetable fiber, which is rich in vegetarian food, is difficult to digest. As for children, in 20% this disease is observed in infants and children. preschool age. The reason for this may be an elongated mesentery or excessive activity.

Types of inversion

Rotation of the stomach is possible around the transverse or around the longitudinal axis. In accordance with this, two types of intestinal volvulus are distinguished:

Transverse or mesenteric-axial torsion. It is formed as a result of twisting of the intestine around the horizontal axis of the stomach, which lies in the middle of the lesser and greater curvature near the gastrohepatic ligament. According to statistics, this species volvulus is diagnosed 3 times more often than a different, longitudinal, type. Transverse rotation is possible both counterclockwise and clockwise. The first option is called anti-peristaltic, the second - isoperistaltic.
Longitudinal inversion occurs when the stomach rotates along its longitudinal axis. There are two possible options. The first - when turning the lesser curvature together with the stuffing box towards the greater curvature. The second is when the turn starts from the posterior compartment of the greater curvature and goes to the distal part, including the omentum.

Causes of the disease

As you know, when digesting food, the stomach rotates around its axis. There are many reasons for stomach torsion. Among the most common are:

Spasm of the stomach. In other words, increased peristalsis or intestinal paresis. It occurs due to the use of a large amount of vegetable fiber. Spasms can be caused by medicines or intestinal infections.
Foreign body. Once in the intestine, it blocks the lumen of the intestine and leads to compression of individual segments of the intestine.
Injuries to the abdominal cavity, which lead to increased pressure.
neuropsychic failures. Powerful contractions of the stomach wall can even lead to a rupture.
A tumor that prevents the contents of the stomach from moving freely.
Adhesive disease. May occur as a complication after peritonitis.
As a result of surgery on the intestines.

Main symptoms

Symptoms of gastric volvulus are determined by the age of the patient, the rate of development of the disease and the degree of bowel rotation. From the clinical side, two phases of the course of the disease are distinguished:

1st - rotation does not exceed 180 degrees.
2nd - rotation reaches or exceeds 180 degrees.

The second phase is characterized by nausea turning into vomiting and noticeable bloating.

The first phase is called chronic gastric volvulus. It is characterized by incompletely closed inlet and outlet openings. At the same time, the patient feels sharp pains, which are periodically repeated and intensified in the direction of the left hypochondrium. Characterized by bloating, a feeling of heaviness and strained in the epigastric segment. IN rare cases dysphagia (impaired swallowing) may occur. On the clinical side, chronic volvulus proceeds easily.

The second phase or acute volvulus. In this case, the inlet and outlet openings of the stomach are completely closed. It proceeds harder than the first phase. This is due to the fact that the pain begins unexpectedly and is characterized by nausea, turning into vomiting and noticeable bloating. Often the pain goes to the back, shoulders and shoulder blades. Characteristic of acute volvulus is regurgitation, even after a sip of water. As a result, the patient feels increased thirst. With an incorrect or untimely diagnosis, the patient's condition deteriorates rapidly. In some cases, there is a deterioration in breathing, a violation of the heart and intoxication.

Both phases are characterized by the absence of stool, bloating, visible to the naked eye, its asymmetrical shape, a feeling of dry mouth, and a sharp and rather strong increase in temperature. When feeling the abdomen, there are seals and pain. During the doctor's palpation, dripping sounds can be heard, which undoubtedly causes discomfort to the patient.

Diagnosis of gastric volvulus

Clinical picture resembles the symptoms of a diaphragmatic hernia. When diagnosed, there is tension in the muscles of the abdominal wall and a bright swelling of the upper left abdomen. In addition, the most informative are x-rays and analyzes. To obligatory laboratory research relate:

General blood analysis. There is an increase in the number of leukocytes.
A barium enema is used during x-rays. At the same time, the type of gastric volvulus is determined.
To determine the amount of fluid and air, a chest x-ray is performed.

Do you have a dog in your house or do you just want to have a pet? Then you need to be aware of all the dangers and diseases that your four-legged friend. And first of all, such a terrible disease can be a volvulus of the stomach. We will tell you about this disease, its causes, symptoms, treatment and much more that will help save your pet's life.

Gastric volvulus in dogs is a hereditary, acute disease with symptoms of gastric obstruction and heart failure. At the same time, a number of serious changes develop in the patient's body, which require immediate surgical intervention. This pathology occurs abruptly and for short term can cause the death of a pet.

At risk this disease, there are dogs of large breeds.

Currently, there are many studies aimed at clarifying the reasons for the appearance of gastric volvulus in dogs, but exact information has not yet been received. It is known that there are several factors that provoke this disease:

At risk are large breeds dogs (St. Bernards, Shepherds, Rottweilers, etc.), as a rule, are older than three years. They have a natural predisposition to this pathology.
The physique of a dog is of great importance in determining its susceptibility to similar disease also because large individuals suffer from weak ligaments and their strong stretching. For this reason full stomach cannot be fixed in the correct position.
The second reason is non-compliance proper diet and nutritional problems. Most dog owners buy low-quality food for their pets, which includes various chemical additives, and many of them vivo are not used by animals. Also, heavy or one-time feeding can become a problem. After all, it is much easier to give out food rarely in large portions. Such a diet causes the expansion of the walls of the stomach and greatly increases its volume, as a result, these walls become weak and flabby.
Stress, huge pressure and hasty feeding result in getting into oral cavity in addition to food, there are also air bubbles that provoke bloating and, as a result, volvulus of the stomach.
Walking immediately after a feed is another major cause of serious stomach ailments, as activity with a full stomach can cause distension.

The mechanism and stages of the development of the disease

Volvulus of the stomach can take place in two directions: the stomach increases and turns into a volvulus, and, conversely, a volvulus, turning into an expansion. The first case involves several stages of the course of the disease:

As a result of a weak contraction of the walls of the stomach, the food that enters it is delayed and causes fermentation, formed a large number of gas bubbles that cause spasms.

The stomach swells significantly and twists around the esophagus, blocking the gases from escaping.
The pressure on the abdominal and thoracic cavity of the body increases sharply.
Water metabolism in the body is disturbed and death occurs.

In the second case, the mechanism of the course of the disease is slightly different:

Stomach filled under the influence physical activity or braking when running is displaced and twisted.
Access to the intestines is closed to the contents of the stomach, fermentation and the formation of gases begin.
The stomach increases in volume to a colossal size, which inevitably leads to the death of the dog.

In all these cases fatality can be avoided if timely action is taken.

Symptoms of stomach torsion

Nausea, vomiting with whitish foam may indicate that the dog has a stomach torsion.

In order to help your pet in time, you need to know the symptoms of the disease. What are the signs of stomach torsion?

excessive salivation in the dog and frequent licking;
nausea, vomiting with whitish foam;
the abdomen swells and hardens;
gums turn pale, sometimes acquire a bluish tint;
the dog shows anxiety, whines, may try to dig the ground;
the back arches, stoop appears;
the dog does not lie down, is constantly in motion;
weakness is observed, loss of consciousness is possible.

Diagnosis of the syndrome of volvulus of the stomach

Diagnosis in most cases does not cause any particular difficulties for an experienced veterinarian. The main criterion for determining the disease will be the clinical picture, which will determine the subsequent treatment tactics.

Additional examinations are not so important and can often only take time to provide medical care. An x-ray examination is considered relevant, since its results will be available in a couple of minutes. Subsequent laboratory medical examinations become useful only after the operation, when it becomes necessary to characterize the current state of the patient.

Differential Diagnosis

Such a diagnosis of the disease consists in the fact that the diagnosis is made taking into account the similarity of the clinical picture of the course of this disease with a similar pathology - acute dilatation of the stomach. It is a bloating of the stomach without twisting it, provoked by acute spasms or closing food access to the intestines as a result of mechanical damage.

With all the similarities, these two diseases should be treated according to different methods. If acute dilatation of the stomach can be cured by the establishment of a gastric tube, then in the second case, an emergency laparotomy cannot be dispensed with.

In the event that the symptoms of the two diseases coincide, treatment is carried out by installing a gastric tube. It can be made from different materials. big dogs, as a rule, put soft rubber or hard plastic probes of various diameters (2-3.5 cm).

Diagnosis of the syndrome of volvulus of the stomach, is reduced to x-ray examination dogs.

If doubts arise when establishing an accurate diagnosis, an x-ray of the stomach is taken and a subsequent analysis of the images, which is carried out taking into account the following criteria:

whether the sphincter separating the stomach and esophagus has shifted;
whether the shape of the stomach filled with gases has changed;
whether the intestines and spleen moved to the right hypochondrium.

If the pictures showed all these changes, then stomach volvulus is diagnosed. If not, then this indicates an acute expansion of the stomach.

Medical tactics

Treatment tactics are based on the analysis of data obtained after clinical examination dogs. Based on it, an algorithm for the provision of medical care is being developed, which includes several principles:

Preparation for surgery cannot be lengthy and must include management pain shock, hypoxia and dehydration.
Proper and appropriate medical intervention.
Subsequent procedures to restore the functions of the digestive system and prevent the occurrence of possible complications.

Important: The basic principle medical tactics considered immediate medical attention.

Preoperative preparation and anesthesia

Preparation of an animal for surgical intervention includes several stages:

reduction of pain;
elimination of problems with cardiopulmonary insufficiency;
recovery water balance in organism;
elimination of toxic and hypoxic ailments.

Dog before surgery.

To solve these problems, the following measures are taken:

an intravenous catheter is inserted through which analgesics, antiemetics, antispasmodics enter the patient's body;
in order to reduce pressure on the chest, the stomach is pierced with a long needle;
anesthesia is provided.

Anesthesia should be performed using tracheal intubation to eliminate the possibility of aspiration syndrome. Anesthesia is performed with the help of proven veterinary drugs: propofol, rompun, ketavet, etc.

Important: A major role in the successful completion of the operation is played by the coordination of the actions of the operating doctor and the anesthesiologist.

Surgical options for gastric volvulus syndrome

After the necessary preparations for surgical intervention the dog is laid on its right side and an incision is made 2-3 cm along left side the lower rib, then an additional piercing of the stomach is performed to completely remove gases.

The unfolding of the stomach is performed by the surgeon manually counterclockwise. After returning the organ to correct position the condition of its partitions is assessed. If more than ¼ of the stomach is damaged, then the risk of a poor outcome increases.

If it is decided to continue the operation, then a probe is installed by the doctor's assistant, through which food masses are removed from the stomach. This is followed by rinsing with saline. The operation ends with gastropexy, that is, the attachment of the stomach to the wall of the abdominal cavity, with the aim of subsequent prevention of the disease. In this case, it is extremely important to choose the right place for gastropexy, because it is this procedure that determines the possibility of subsequent restoration of the damaged organ.

The operation lasts up to 90 minutes.

This operation lasts from 30 to 90 minutes. The given technique is the simplest and known to every doctor.

If the animal was delivered to veterinary clinic up to 4 hours after inversion, that is, the possibility of stem vagotomy. This option is good because it reduces the risk of death to 3%.

There are other methods of surgical intervention, but the experience of their use proves their ineffectiveness, since they only increase the amount of time spent on the operation.

Rationale for vagotomy and technical aspects of its implementation

Vagotomy is surgery, consisting in the fact that the main trunk of the vagus nerve is dissected.

The results of experimental studies show that this type of surgical intervention is the most effective and virtually eliminates the risk of death.

There are a number of indications for this operation:

It should take no more than 4 hours from the appearance of the first symptoms of volvulus.
The animal must not have severe complications, which may affect the result of the operation.
Relatively normal condition patient, the ability to withstand additional time.
postoperative period and possible complications

Vagotomy is the most effective type of surgery.

Volvulus of the stomach can leave behind serious consequences associated with disruption internal organs leading to cardiopulmonary or kidney failure, acute pancreatitis, ulcer formation. Therefore, in postoperative period The animal needs special care. It includes:

Medical treatment, consisting of antibiotic therapy, infusion therapy, taking antiemetic drugs and gastroprojectors.
2-3 days under observation in the hospital.
Special hungry diet in the first 1-5 days.

Following these requirements will help prevent the possibility of complications and relapse.

Possible post-vagotomy complications of the late postoperative period

Complications after vagotomy occur only in 9% of cases and have different levels severity: mild to severe. Among these complications are:

diarrhea
problems with the gallbladder;
dysphagia;
gastric stasis;
duodenostasis.

In 9% of dogs, complications of the late postoperative period are possible.

What can be confused with gastric volvulus

In addition to acute dilatation of the stomach, gastric volvulus has similar symptoms with a number of other diseases:

That's why accurate diagnosis can only be delivered by a doctor after a thorough examination.

Watch the video material from the veterinarian.

Disease prevention

Proper prevention of gastric volvulus.

Feed must be of high quality, not heavy and easily digestible.
You can not serve food in one large portion once a day, it is best to divide this portion into 3-4 meals.
Must be abandoned vigorous activity before and after feeding.
If your dog has hereditary predisposition to a similar pathology, it is worth doing a preventive operation that reduces the risk of its occurrence.

The positive outcome of such a disease largely depends on the vigilance of the owners and timely access to an experienced doctor.

Volvulus of the stomach is a rather rare disease, moreover, little known to doctors. The main clinical manifestations of gastric volvulus resemble, in principle, the symptoms high obstruction GIT. In the absence of diagnosis and treatment, the disease is dangerous for human life and ends in death.

Conditions for an abnormal reversal of the stomach along the transverse or longitudinal axis are created as a result of the convergence of the pylorus and cardia, lengthening of the ligamentous apparatus, gastric overflow, increased peristalsis and vomiting.

Patients need urgent hospitalization in an inpatient surgical department for immediate surgical intervention, namely, straightening the volvulus and using a gastric cavity emptying probe.

The disease occurs, according to statistics, at any age, but 40-50-year-olds are most susceptible to it. Somewhere around 20% pathological diseases occur in infants.

There is evidence that directly indicates the possibility of the occurrence of gastric volvulus in persons with gastroptosis, gastric ulcer, perigastritis, cicatricial deformity, atony of the stomach, a tumor of the stomach, in which an adhesive process is observed in the abdominal cavity, aerophagia.

Diaphragm disease is a particularly predisposing factor for the progression of gastric volvulus. Especially - paraesophageal hernia. Much less often, the disease occurs in a hernia of the sliding esophageal opening of the diaphragm, hernias of Larrey-Morgagni, Bochdalek, with relaxation of the diaphragm and traumatic diaphragmatic hernia.

There is evidence of gastric volvulus and in the case of surgical interventions: selective vagotomy, gastrostomy, Lewis operation, Nissen fundoplication.

The triggering factor for the onset of the disease may be an increase in intra-abdominal pressure due to abundant food, abdominal trauma, vomiting, physical activity.

Volvulus of the stomach according to its etiology is divided into two types - congenital or acquired and idiopathic.

Usually, the idiopathic type is observed in 2/3 of all patients and develops due to the weak state of the ligamentous apparatus of the stomach, which helps to bring the pylorus and cardia closer together with a full stomach.

The second type is observed in 1/3 of patients and directly depends on acquired or congenital abnormalities leading to excessive stomach mobility.

Volvulus of the stomach is acute and chronic. The first occurs, as a rule, less often than chronic and occurs equally often regarding both axes of the stomach. As for the chronic type, the disease is the result of a rotation of the stomach about the transverse axis.

Symptoms

Symptoms usually depend on the age of the patient, the rate of development of the disease, the degree of gastric torsion.

IN clinical course diseases are divided into two main phases:

1st - volvulus did not reach 180° and there is no complete closure of the lumen of the pyloric and cardiac parts of the stomach;
2nd - torsion reaches 180 ° and there is a complete closure of certain parts of the stomach.

Acute volvulus of the stomach occurs suddenly and is mainly characterized by intense pain in the left hypochondrium and epigastric region, sometimes radiating to the chest (its lower sections) and back.

There is repeated vomiting with passable cardia. Does not provide relief to patients. Due to swelling in the epigastric region, asymmetry of the abdomen is observed, which is moderately painful on palpation.

In the first hours after the torsion of the stomach has occurred, there may be stool and gas discharge, and peristaltic enhanced noises are also heard. In the case when the pylorus and cardia are completely closed, the patient's condition worsens. There is bloating, pain intensifies.

Over the swollen area of the abdomen, during a physical examination, intestinal noises disappear and high tympanitis is revealed, regurgitation occurs after only a few sips of water, swallowing is almost impossible, thirst increases.

When the stomach turns in relation to the longitudinal axis, the following are observed: involuntary repeated vomiting, acute and severe pain in the epigastric region, the impossibility or difficulty of passing the probe into the stomach.

In acute volvulus of the stomach (with diseases and congenital anomalies of the diaphragm), the course of which is localized in pleural cavity, there are sharp pains in the epigastric region and chest radiating to the shoulder, shoulder blade, shortness of breath is observed.

Diagnostics

The clinical picture of this abnormal disease resembles a strangulated diaphragmatic hernia. Such a phenomenon as bloating of the upper left quadrant of the abdomen is a hallmark of gastric volvulus. Visually observed increased peristalsis of the stomach.

Relaxation of the left side of the diaphragm is one of the most common causes of gastric volvulus. A torsion of the stomach is also possible if it is in a diaphragmatic hernia. Due to obstruction, all attempts to insert a gastric tube are unsuccessful. Clarify the diagnosis with the help of an X-ray examination in a hospital, which is taken immediately.

The acute course of gastric volvulus, as a rule, is manifested by severe intoxication, dystrophic changes in parenchymal organs, severe metabolic disorders and hemodynamic disorders. The diagnosis is based mainly on the data of clinical examination and X-ray examination.

It is quite difficult to diagnose gastric volvulus in relation to the longitudinal axis, especially if no diaphragmatic defect is observed.

It is possible to reveal on the radiographs the high standing of the diaphragm and the existence of a large gas bubble with a liquid level - horizontal.

In the stomach, with a twisting about the transverse axis of the organ, during an x-ray examination (the patient is in a standing position), two levels of fluid are detected: the first is in the fundus of the stomach, the second is in the body of the stomach.

X-ray contrast study is also important in identifying diseases of the diaphragm, leading to the formation of chronic gastric volvulus.

Although alkaline phosphatase and amylase may be elevated, laboratory findings are nonspecific.

Prevention

The disease is so rare that special preventive measures do not exist today.

Treatment

Treatment of gastric volvulus is exclusively surgical. Conservative measures can sometimes be successful, but they do not eliminate the causes leading to volvulus. In case of gastric volvulus, gastric decompression should be performed immediately. If it is not possible to install the probe, then attempts should be abandoned, as this may well contribute to the perforation of the stomach wall, especially in children.

Untimely surgical treatment leads to the progression of severe complications and increased mortality.

Perforation of the wall with the development of peritonitis, as well as necrosis, are the most common complications of acute gastric volvulus. Necrosis of the stomach wall due to a strong blood supply to the stomach occurs only in 5-28% of all cases. Complications most common: acute pancreatitis, rupture of the spleen, rupture of the common bile duct, jaundice, gastric bleeding due to the formation of acute ulcers.

Mortality in acute gastric volvulus ranges from 30 to 50%, in case of complications with necrosis of its wall, it reaches 60%.

The median laparotomy is considered the most common surgical intervention. Volvulus of the stomach, which was complicated by necrosis of the wall directly in the hernia of the opening of the esophageal diaphragm, is an indication for thoracotomy.

Straightening of the stomach is the main stage of the operation, but it is performed only after decompression of the organ. For this, gastrostomy and gastric puncture are performed.

Necrosis of the stomach wall is also an indication for resection of the stomach, and sometimes gastrectomy.

Often, after straightening the volvulus of the stomach, a relapse of the disease occurs, and here surgeons disagree. Some believe that the operation should end with a gastropexy, while others - with a gastrostomy. Some surgeons usually use both of these interventions.

Today there are data on the use of the laparoscopic method in chronic gastric volvulus.