318 Torsion of the Stomach. 



Ellerniann ; Bonviiici reported one case in Italy, v. Ratz two 

 cases in Hungary, Markns five cases in Holland. 



Only one case of torsion of the rennet in a calf eight days 

 old has been reported by Carougeau & Prestat. 



Etiology. It is owing to the great mobility of the pyloric 

 half of the stomach, including the pylorus in dogs, that in cer- 

 tain movements, such as jumping, rolling, rapid running up- 

 stairs, the stomach easily changes its position. Since the stomach 

 is sufficiently fixed by the abdominal wall and the abdominal or- 

 gans, when completely filled, it can only change its position 

 either if it is entirely empty or if it contains such bodies as 

 pieces of bone, meat or liver which may produce a swinging 

 motion of the stomach during the indicated movements. 



Pathogenesis. The pyloric half of the stomach and the 

 duodenum get from behind the surface of the liver on the right 

 side of the abdominal cavity, into the left side between the ab- 

 dominal portion of the esophagais, the cardia of the stomach and 

 the liver, where it will be compressed ; at the same time the ab- 

 dominal portion of the esophagus turns in a direction like the 

 hand of a clock (seen from behind). In consequence of this 

 change of position, both openings of the stomach become closed, 

 the veins of the stomach and those of the spleen, which is forced 

 to follow the change of position of the stomach, become partially 

 or completely obstructed in consequence of pressure and tor- 

 sion. The less collapsible and more resistant arteries, in which 

 there is a high blood pressure, continue to propel an almost nor- 

 mal amount of blood into the vessels of the stomach and spleen, 

 and a rapidly increasing profound venous congestion is devel- 

 oped. Excess of carbon-dioxide in the gastric vessels causes 

 convulsive colicky pains and contractions of the gastric wall, 

 which will only cease after several hours and after bloating and 

 edematous infiltration of the gastric wall have developed. Pain 

 is also caused by a torsion of the nerves and by the development 

 of peritonitis. Since nothing can pass from the stomach 

 and since absorption into the blood is almost abolished, the 

 stomach becomes quickly and enormously dilated by gases which 

 develop from food stuffs that may be present, and from the hem- 

 orrhagic infarction with serum extravasation, which has been 

 caused by the torsion. The more feed there is present in the 

 stomach, and the more severe the twisting, the more rapidly 

 will bloating attain a dangerous degree. The enlarging stom- 

 ach interferes with the movements of the diaphragm and in this 

 manner and also in consequence of a developing general infec- 

 tion, eventually also of peritonitis, which is caused by microbic 

 invasion through the damaged stomach wall, disturbances of 

 circulation are produced. 



Anatomical Changes. Sometimes the stomach is enlarged 

 and bloated to ten times its normal volume ; the pyloric half and 



