Visceroptosis - Symptoms, Diagnosis, and Management

Introduction:

The abdomen comprises various internal organs like the small and large intestines, stomach, liver, spleen, gallbladder, pancreas, uterus, fallopian tube, ovaries, kidney, urinary system, and various blood vessels. When these organs are displaced from their normal position, it can be called visceroptosis. Visceroptosis, a condition of abdominal viscera, can cause various gastrointestinal symptoms based on the severity and compression of abdominal internal organs and the sharp curvature of blood vessels, nerves, and ducts. If the displacement occurs in one single organ, it is termed gastroptosis (stomach), nephroptosis (kidney), enteroptosis (intestines), and splenoptosis (spleen).

What Is the Epidemiology of Visceroptosis?

This condition is often seen in women. The hereditary type is an inherited disorder that manifests symptoms during puberty. The incidence of visceroptosis is unknown. However, studies suggest that a relaxation of the abdominal organ's ligaments might be the cause.

What Are the Different Types of Visceroptosis?

Ebright has classified visceroptosis as:

1. Hereditary Type: The individual has inborn internal organ defects leading to the condition's development.

2. Acquired Type: The individual develops this condition due to underlying pathology such as prolonged illness (syphilis, tuberculosis, alcoholism), frequent pregnancies, or sudden weight loss, with weight loss being the most common etiology. Repeated pregnancy can cause relaxation of the abdominal walls and pelvic floor, causing the condition’s development.

What Are the Symptoms of Visceroptosis?

Individuals with visceroptosis are often misdiagnosed and treated for other conditions with little improvement in their symptoms. In addition, surgical treatment after a misdiagnosis can lead to worsening symptoms.

• General symptoms include chronic trouble with digestion, such as:

  • Patients have good appetite but feel distention two to three hours after food intake.

  • Dull ache in the abdomen.

  • Belch (excess air released through the mouth).

  • Weight loss and loss of strength.

  • Nausea.

  • Anorexia (eating disorder).

  • Flatulence (expulsion of air from the anus).

  • Frequent headaches.

  • Vomiting.

  • Lower resistance to widespread infections and constipation.

• Other symptoms include:

  • A flat chest and a perpendicular heart.

  • Low blood pressure.

  • Eye troubles.

  • Pain in the neck and shoulder.

  • Menstrual troubles.

  • Furthermore, subcutaneous adipose tissue is significantly reduced, resulting in decreased support for abdominal organs and decreased organ temperature.

  • Sometimes the symptoms get worse and look like appendicitis or gallbladder stones, which are also inflammatory conditions of the abdomen.

• Symptoms in the hereditary type are the following:

  • Tall, lean, and stooping.

  • A flexible vasomotor system.

  • Long flat thorax.

  • Low blood pressure.

  • Weak ankles with flat feet.

  • Peristaltic waves are slow and weak, causing the food to stay in the stomach longer, leading to anorexia, nausea, and gas.

  • The individual, while vomiting, may expel food consumed the previous day.

  • The acute pain results from the intestine being filled with feces, leading to the development of the irritable condition in the ileo -cecal valve and in the last portion of the ileum.

What Is a Bilious Attack?

When feces accumulate in the large intestine, they irritate the ileocecal valve, triggering its closure to prevent further bowel filling. It causes a reflex contraction of the pylorus, causing pain and peristalsis in the stomach. The stomach’s effort to overcome spasms results in the relaxation of the cardiac sphincter to vomit food and gastric secretions. The bile and duodenal contents regurgitate into the stomach and are vomited after a pyloric spasm, giving temporary relief. The cycle of events is termed a bilious attack and often occurs in visceroptosis.

What Are the Conditions Associated With Visceroptosis?

• Hypermobility Ehlers-Danlos syndrome is associated with visceroptosis. Rectum prolapse and GI (gastrointestinal) symptoms are seen. However, few cases with this association are reported.

• Visceroptosis associated with weight loss can be seen in rapid and sudden weight loss. Weight gain can relieve symptoms. Physicians cannot treat the condition due to limited food intake caused by visceroptosis.

• Visceroptosis is associated with neurological conditions. The individual experiences weakness, nervousness, syncope, and insomnia. However, the association between visceroptosis and nervous disorders remains unclear.

• Visceroptosis has been reported after a hysterectomy or a tumor mass. Tumors of the abdomen act as a support to abdominal organs and cause prolapse after the tumor removal.

What Is the Diagnostic Feature of Visceroptosis?

• General diagnostic features are:

  • Medical history and physical examination are important for diagnosis.

  • A palpable kidney and a prominent abdomen in the lower half are diagnostic features.

  • In prone positioning, the abdomen is normal in contour and distended is upright.

  • The liver, spleen, and kidney become palpable with tenderness in the epigastrium on deep palpation.

  • Lab tests and X-ray examinations are done to rule out other abdominal disorders.

  • Gastric analysis detects stasis (inactivity) and the absence of obstruction; in addition, the acidity of stomach secretions is reduced.

  • Fluoroscopy detects gastric peristaltic waves that are weak.

  • Barium swallow detects enteroptosis.

• Diagnostic features of hereditary visceroptosis are:

  • X-ray examination showed a “drop” heart appearance with unattached 9th and 10th ribs.

  • The stomach appears low, atonic, and less dilated.

  • The mesentery elongates, causing the small intestine to sag into the pelvis.

  • The musculature of the small intestine becomes flabby, and the nervous system causes abnormal contractions, and dilatation of the bowels, causing pain.

  • The caecum and colon become atonic, sluggish, and displaced, filled with feces and causing constipation.

How Is Visceroptosis Managed?

• Non–Surgical Management:

  • The measures to manage the condition are to be followed for a lifetime.

  • Limiting food and liquid intake and lying down after taking food to prevent overloading and pain.

  • Consuming dry food is advised.

  • Increased carbohydrate intake as they are digested easily.

  • Patients must consume fluids between meals.

  • A routine exercise with bending the thigh towards the body and massaging can strengthen abdominal muscles.

  • Weak abdominal muscles are supported with an abdominal belt.

  • A diet of 3500 to 4000 calories is required for weight gain.

  • Regular bowel movements are essential to prevent a bilious attack.

  • Paraffin oil is beneficial for inducing bowel movements.

• Surgical Treatments: These are advised when all the other nonsurgical treatments fail:

  • First, the caecum is raised and fixed in the iliac fossa to empty the bowel.

  • Laparoscopic surgical procedures may help fix displaced organs.

What Is the Complication Associated With Visceroptosis?

Possible development of superior mesenteric artery syndrome.

What Is the Prognosis of Visceroptosis?

Most cases are asymptomatic and do not have any symptoms. However, a few cases show symptoms that may worsen with age. These cases, when treated non-surgically, help alleviate the symptoms. However, the prolonged non-surgical treatment causes the patient's condition to worsen. As a result, the individuals fail to get relief from pain and constipation, and their nutritional status worsens.

Conclusion:

The condition is not considered a disease, and adequate knowledge about the disease needs to be improved among physicians, causing misdiagnosis and failed treatment. Therefore, adequate studies must be conducted to understand the causes, mechanisms, and treatment methodology for good outcomes.