Gastric eversion is a rare, life-threatening medical event where a portion of the stomach is turned inside out. This condition involves the stomach wall or its mucosal lining passing through an opening, such as the gastroesophageal junction. Clinically, true eversion is often linked to acute gastric volvulus, a severe mechanical issue. This acute process requires immediate diagnosis and surgical intervention due to the risk of tissue death and shock.
Defining Gastric Eversion and Its Anatomical Reality
True gastric eversion, also known as mucosal prolapse, involves the stomach’s inner lining pushing outward through a natural or artificial opening. In humans, this event is uncommon, often occurring as a complication of a pre-existing anatomical flaw or surgical procedure. The most frequent mechanical problem leading to partial eversion is acute gastric volvulus, where the stomach twists on its axis by 180 degrees or more.
Volvulus is categorized based on the axis of rotation. The organoaxial type is the most common, involving rotation along the line connecting the entrance and exit of the stomach. This twisting seals both the esophagus and the duodenum, creating a closed-loop obstruction. The stomach’s position is normally secured by ligaments, but laxity or defects in these attachments allow for abnormal mobility, setting the stage for volvulus or eversion.
Primary Causes and High-Risk Contexts
The causes of gastric eversion and volvulus are rooted in structural abnormalities that compromise the stomach’s fixed position. The most common predisposing factor in humans is a large paraesophageal hernia, a diaphragmatic defect where part of the stomach slides into the chest cavity. This displacement allows the stomach to rotate freely, sometimes leading to an “upside-down stomach” and subsequent volvulus. Congenital defects in the diaphragm or laxity in the supporting gastric ligaments also increase the risk, particularly in children.
Acquired causes include complications following specific surgical procedures, such as gastrostomy tube placement or bariatric surgery, which can weaken the surrounding tissue. Severe trauma to the abdomen can also destabilize the stomach’s anatomical anchors, leading to acute rotation. The term is also encountered in veterinary medicine regarding Gastric Dilatation-Volvulus (GDV), a condition seen in large dog breeds.
Clinical Recognition and Emergency Management
The onset of acute gastric eversion or volvulus is marked by sudden, intense symptoms requiring emergency medical attention. The classic presentation for acute volvulus is Borchardt’s Triad, which includes severe upper abdominal pain, non-productive retching, and the inability to pass a nasogastric tube. These signs indicate a complete obstruction at both the entrance and exit of the stomach.
Other signs include rapid progression to hypovolemic shock, abdominal distension, and instability of vital signs, resulting from compression of major blood vessels and tissue ischemia. Diagnosis is confirmed using imaging studies. X-rays often reveal a large, air-filled stomach bubble or a double-bubble sign, while a CT scan or contrast study can show the abnormal positioning and obstruction.
Emergency management focuses on patient stabilization, involving fluid resuscitation to counteract shock and attempts at gastric decompression. Although a nasogastric tube may be attempted, the obstruction often prevents its successful passage. Due to the high risk of tissue death and perforation (up to 50% for acute volvulus), definitive treatment is an immediate surgical procedure. Surgery reduces the twisted or everted stomach to its normal position and often includes gastropexy to permanently fix the stomach wall to the abdominal wall, preventing recurrence.