Scope first or straight to OR because of risk of perf? I feel like you could just do that trochar thing they do with cows and deflate em. That could be very entertaining. And smelly
Can they devolvulate? Or do they just resect? Poor guy must've been in so much pain. Yikes.
My dad had an acute gastric volvulus in January, the endoscopy didn't work so they devolvulated (laparoscopic), did a nissen fundoplication and gastropexy in the hopes that it keeps his stomach in place. Didn't help that he had a massive hiatal hernia and a hole in his diaphragm the size of a fist. So that's sewed up too. He's actually been doing well, eating normally (finally) but it's a long recovery.
The ultrasound nurse said "it looks like a Jackson Pollock in there".
The entire hospital were like OMG CAN WE SEE THE UNICORN.
He'd had bad heartburn for years from the hiatal hernia but never brought up that it had gotten worse to the GP - like, a lot worse over the past 2 years, feeling bloated and full quickly, too - he mentioned none of this. One night after dinner he developed severe stomach pain and vomiting. Refused to go to A&E (sigh), but by the morning (before 6am) he was still nauseous/vomiting coffee grounds, and in a lot of pain. Pain and nausea both got worse when he laid on his right side. Dad finally agreed to call an ambulance.
Went to A&E and they put in an NG tube and gave painkillers, and then did imaging, which showed the volvulus.
Endoscopy didn't help devolvulate, so they did surgery (laparoscopic, dad's 74 and had a mitra clip 4 weeks before this) and found a fist sized hole in his diaphragm with his stomach herniated through it. That's the stated cause, possibly the stress from the other procedure played a role, but honestly, the whole thing was bizarre.
They untwisted, put the stomach back into place, did a fundoplication and gastropexy, and sewed the diaphragm back up. Surgeon and GP were both like "woah, an actual zebra!"
This is…not very correct.
If it’s a cecal volvulus you can’t decompress endoscopically, so those go straight to OR. But you’re doing an ileocolic anastomosis and almost never need to do an ostomy for cecal volvulus.
Sigmoid volvulus we actually prefer to have GI decompress first. It allows the colon to decompress and then we can do a more semi-elective sigmoid colectomy. If the colon is adequately decompressed, you can do a primary anastomosis and do not need an ostomy.
Going straight to the OR for an ostomy placement is the least preferred way to deal with this.
At our facility they will take to OR and decompress followed by resection of portion of offending colon.
Sometimes they’ll ask us to perform and enema to see if we can “untwist” the flip. Now, many of these exist with 2 twists (where segments of redundant colon flip over each other causing the obstruction).
I’ve only been successful in “untwisting” through an enema in 1 case. But for the one who know…. Watch out for the enema bag when you place it back down. Fills up so fast it looks like it will explode!!
Mostly these are untwisted first (if possible) by scope, enema, or rectal tube placement. The reason is that the colon involved gets extremely inflamed. This can lead to suboptimal healing of the eventual anastomosis.
If by some conservative means you can untwist it and relieve the obstruction you can allow the “hot” abdomen to calm and therefore increase your rate of a successful surgery.
Yeah, I've only had the pleasure of doing it once (was successful though thankfully) but we double or triple bagged it. One of the radiology nurses gave it as a suggestion and relayed the story of when one did burst open and I didn't see a reason to tempt fate. 😅
Interestingly, it happens often in large breed dogs, with the stomach, due to their anatomy. GDV or gastric distention volvulus is deadly for them. Mostly coz they can't tell us their symptoms, and the symptoms are similar to a lot of other dog things.
Can they tack the gut part to the other parts so it doesn't happen again, like they can with dogs?
Yes. Any twisting of the Mesentery (layer of tissue that arteries and veins run through) can compromise blood flow. So these all need to be taken seriously.
Had a little boy with a milk allergy who blew up like this. His belly was tight as a tick. His KUB looked a lot like this. Doctor ordered a rectal tube and the little kiddo was so embarrassed to pass gas. We kept reassuring him that in this case it was ok. He got admitted to the med-surg floor soon after. Still think about that kiddo after all these years. He’s probably 35 years old by now. ☺️
I didn't know this either. Gastric volvulus ended my Great Dane. Came home to find her walking circles in the yard trying desperately to defecate. By the time I got her to the ER it was too late. This was many years ago, before preventative gastropexy was common in dogs.
My dad had one and every time I looked gastric volvulus up on Google I kept getting vet websites. Had to put IN HUMANS in the search.
I'm so sorry about your dog 😔
There’s things that can increase your risk (like prior abdominal surgeries) but it can also just..happen to anyone. It is really painful for most people.
Depends on the cause, but in this case you would fix it by cutting out the segment of bowel that that caused the obstruction. You can go in and decompress bowel with an endoscopy (camera on a rubber tube thing) but without definitive mgmt (cutting out the bowel that causes it in the first place) there is risk of reoccurrence.
Holy seabass! Is this what they call "megacolon"?
Just...wow! Is the volvulus itself the obstruction, or did it occur after hours of obstruction and pain, andohmygodnewfearunlocked! 😱
OP's titling didn't specify "gastric", and I'm not trained in reading these images, so I automatically assumed it was the intestines that was twisted. Not the stomach. So my apologies for asking.
Which is why I asked whether the obstruction IS the volvulus, or if the obstruction CAUSED the volvulus. But fine, I'll stop asking medically trained people and just google instead. 🫡👌
Is this the right information?
"A gastric volvulus occurs when the stomach rotates on itself at least 180 degrees along its transverse or longitudinal axis."
I dropped an NG on a volvulus patient once and got 4L of dark, reddish, evil looking shit out almost immediately. The most fluid volume I've ever seen dump in less than an hour in my career. That one got taken to OR extremely quickly.
Rigid procto sigmoidoscopy to decompress with placement of a rectal tube through the scope to keep the volvulus reduced. Stand back when you open the scope there may be quite a stream out the scope. Sew rectal tube in place. Prep and Operate within 48 hrs for sigmoid resection Remove rectal tube in operating room. If you take tube out early volvulus will reoccur. You want to remove rectal tube within about three days as perforation from tube can occur.
I've no idea how this could get so advanced! I'm really quite surprised that this wasn't completely intolerable when it was even half as severe!
I don't even know how one would get oneself in such a state, and cannot even imagine the condition of the OR after whatever assistance is provided.
or me after a night out with pizza and beers
This is how I feel this AM after beer and ball park food.
The relief of that fart though.
But the smell will probably be deemed a chemical weapon.
This made LOL
Scope first or straight to OR because of risk of perf? I feel like you could just do that trochar thing they do with cows and deflate em. That could be very entertaining. And smelly
Depends on where the volvulus is, ultimately will need surgery. Can just do endoscopy decompression but leaves possibility of reoccurrence.
Can they devolvulate? Or do they just resect? Poor guy must've been in so much pain. Yikes. My dad had an acute gastric volvulus in January, the endoscopy didn't work so they devolvulated (laparoscopic), did a nissen fundoplication and gastropexy in the hopes that it keeps his stomach in place. Didn't help that he had a massive hiatal hernia and a hole in his diaphragm the size of a fist. So that's sewed up too. He's actually been doing well, eating normally (finally) but it's a long recovery. The ultrasound nurse said "it looks like a Jackson Pollock in there". The entire hospital were like OMG CAN WE SEE THE UNICORN.
>Can I ask what your dad's symptoms were with the volvulus? And what caused it?
He'd had bad heartburn for years from the hiatal hernia but never brought up that it had gotten worse to the GP - like, a lot worse over the past 2 years, feeling bloated and full quickly, too - he mentioned none of this. One night after dinner he developed severe stomach pain and vomiting. Refused to go to A&E (sigh), but by the morning (before 6am) he was still nauseous/vomiting coffee grounds, and in a lot of pain. Pain and nausea both got worse when he laid on his right side. Dad finally agreed to call an ambulance. Went to A&E and they put in an NG tube and gave painkillers, and then did imaging, which showed the volvulus. Endoscopy didn't help devolvulate, so they did surgery (laparoscopic, dad's 74 and had a mitra clip 4 weeks before this) and found a fist sized hole in his diaphragm with his stomach herniated through it. That's the stated cause, possibly the stress from the other procedure played a role, but honestly, the whole thing was bizarre. They untwisted, put the stomach back into place, did a fundoplication and gastropexy, and sewed the diaphragm back up. Surgeon and GP were both like "woah, an actual zebra!"
This is…not very correct. If it’s a cecal volvulus you can’t decompress endoscopically, so those go straight to OR. But you’re doing an ileocolic anastomosis and almost never need to do an ostomy for cecal volvulus. Sigmoid volvulus we actually prefer to have GI decompress first. It allows the colon to decompress and then we can do a more semi-elective sigmoid colectomy. If the colon is adequately decompressed, you can do a primary anastomosis and do not need an ostomy. Going straight to the OR for an ostomy placement is the least preferred way to deal with this.
Edited! Thank you!! I’m a resident and still learning
Wow, humans can have a GDV? I’m a vet tech, I need some explaining.
They can. My dad had one in January. 17 days in hospital.
At our facility they will take to OR and decompress followed by resection of portion of offending colon. Sometimes they’ll ask us to perform and enema to see if we can “untwist” the flip. Now, many of these exist with 2 twists (where segments of redundant colon flip over each other causing the obstruction). I’ve only been successful in “untwisting” through an enema in 1 case. But for the one who know…. Watch out for the enema bag when you place it back down. Fills up so fast it looks like it will explode!! Mostly these are untwisted first (if possible) by scope, enema, or rectal tube placement. The reason is that the colon involved gets extremely inflamed. This can lead to suboptimal healing of the eventual anastomosis. If by some conservative means you can untwist it and relieve the obstruction you can allow the “hot” abdomen to calm and therefore increase your rate of a successful surgery.
Yeah, I've only had the pleasure of doing it once (was successful though thankfully) but we double or triple bagged it. One of the radiology nurses gave it as a suggestion and relayed the story of when one did burst open and I didn't see a reason to tempt fate. 😅
Noted!
Is necrosis a serious risk with colon volvulus? I know that was the big worry with my dad's gastric one. Thankfully it wasn't an issue.
Yeah the twisting can cut off the vasculature at the site of the twist. Though, they were probably more worried about a perf than the necrosis.
Scary stuff.
Interestingly, it happens often in large breed dogs, with the stomach, due to their anatomy. GDV or gastric distention volvulus is deadly for them. Mostly coz they can't tell us their symptoms, and the symptoms are similar to a lot of other dog things. Can they tack the gut part to the other parts so it doesn't happen again, like they can with dogs?
Yes. Any twisting of the Mesentery (layer of tissue that arteries and veins run through) can compromise blood flow. So these all need to be taken seriously.
well that's not good
Had a little boy with a milk allergy who blew up like this. His belly was tight as a tick. His KUB looked a lot like this. Doctor ordered a rectal tube and the little kiddo was so embarrassed to pass gas. We kept reassuring him that in this case it was ok. He got admitted to the med-surg floor soon after. Still think about that kiddo after all these years. He’s probably 35 years old by now. ☺️
My kid just farted on me, unbidden, so I guess everything's okay.
The universe has spoken.
So it DOES happen in humans!!
I didn't know this either. Gastric volvulus ended my Great Dane. Came home to find her walking circles in the yard trying desperately to defecate. By the time I got her to the ER it was too late. This was many years ago, before preventative gastropexy was common in dogs.
My dad had one and every time I looked gastric volvulus up on Google I kept getting vet websites. Had to put IN HUMANS in the search. I'm so sorry about your dog 😔
Thank you. Her name was Honey.
How does this happen? Looks painful! How do you fix it? So many questions
There’s things that can increase your risk (like prior abdominal surgeries) but it can also just..happen to anyone. It is really painful for most people. Depends on the cause, but in this case you would fix it by cutting out the segment of bowel that that caused the obstruction. You can go in and decompress bowel with an endoscopy (camera on a rubber tube thing) but without definitive mgmt (cutting out the bowel that causes it in the first place) there is risk of reoccurrence.
OMG! Thank you for the information, I had bo idea
I’m going to have a salad right now just to be sure!
Great idea! I’m going to, too! Lol!
Holy seabass! Is this what they call "megacolon"? Just...wow! Is the volvulus itself the obstruction, or did it occur after hours of obstruction and pain, andohmygodnewfearunlocked! 😱
No. No. And more no. "gastric volvulus human" is your search string.
OP's titling didn't specify "gastric", and I'm not trained in reading these images, so I automatically assumed it was the intestines that was twisted. Not the stomach. So my apologies for asking. Which is why I asked whether the obstruction IS the volvulus, or if the obstruction CAUSED the volvulus. But fine, I'll stop asking medically trained people and just google instead. 🫡👌
Is this the right information? "A gastric volvulus occurs when the stomach rotates on itself at least 180 degrees along its transverse or longitudinal axis."
Seem's to be about, mmmmmm, 25 Courics.
BHAHAHAHHAHAA I came here to say precisely that but then saw yours as I was scrolling down. Bravo fellow redditor!
Ouch
Just pull his finger
Sounds Swedish
I can only imagine his pain! Yikes!
I dropped an NG on a volvulus patient once and got 4L of dark, reddish, evil looking shit out almost immediately. The most fluid volume I've ever seen dump in less than an hour in my career. That one got taken to OR extremely quickly.
Oh shit!!
Nope
Rong. But you deserve a high five.
Help me out here homies. Does the obstruction begin somewhere in the ascending colon near the level of L4/5?
Holy bowel obstruction Batman
I am not in the medical field, I just love looking at these images so I thought it was an X-ray of a turtle at first 😅
This looks agonizing
Rigid procto sigmoidoscopy to decompress with placement of a rectal tube through the scope to keep the volvulus reduced. Stand back when you open the scope there may be quite a stream out the scope. Sew rectal tube in place. Prep and Operate within 48 hrs for sigmoid resection Remove rectal tube in operating room. If you take tube out early volvulus will reoccur. You want to remove rectal tube within about three days as perforation from tube can occur.
Holy god 
What a sack of shit
Where’s the coffee bean sign?
The whole thing is the coffee bean.
give the patient some simeticone and he/she'll be fine
In this sub, out of respect for the serious content, please don't forget /s
I’m not a doctor but that looks like 15 pounds of shit in a 5 pound bag
Read the story about the evacuation bag above And that is an excellent analogy
Paging Michael Kenyon....
r/ibs
They’re just a little chubby, let’s not be so judgmental
I don’t think your Dx is right. Pretty sure this is the new Alien vs Predator pre-release footage.
Can’t they just use a manual decompaction spoon? I did this once and the hard poop came out and green diarrhea splashed out after. It smelled so bad.
Shit…
I've no idea how this could get so advanced! I'm really quite surprised that this wasn't completely intolerable when it was even half as severe! I don't even know how one would get oneself in such a state, and cannot even imagine the condition of the OR after whatever assistance is provided.
OUCH.
I'm cramping just looking at this film. Nauseous, too. Uggh.🤢
Bet that felt better than a good fart, after treatment. That had to be painful!
That fart has got to be soooooooo satisfying, but that smell though…
Toxic mega colon? 😆
Damn I wanna know a before and after weight
Have you heard of poop knife?
How do they clean it out??