When Has Visceroptosis Clinical Significance?

This paper is based on a study of hospital- and out-patients sent to the Department of Roentgenology for a diagnosis of gastro-intestinal pathology. Twenty per cent of the patients examined have clinical visceroptosis. The responsibility for the diagnosis rests upon the roentgenologist. Visceroptosis has undoubtedly occurred since man assumed the upright position. In 1833 Glénard published his thesis on this subject, since which time visceroptosis has been called “Glenard's disease.” It has been defined as a prolapse or falling or dropping of the viscera. When it involves the stomach it is termed “gastroptosis”; the intestines, “enteroptosis”; the colon, “coloptosis”; the liver, “hepatoptosis,” and the kidneys, “nephroptosis.” The subject of visceroptosis has been studied for many years, but it is only since the discovery of the X-ray and the use of the opaque meal that exact observations have been made. At the present time there is much difference of opinion as to the degree of prolapse which is to be regarded as pathologic. Only the two most common manifestations of visceroptosis, namely, gastroptosis and coloptosis, will be considered in this paper. It should be emphasized that there is a marked difference between anatomic and clinical visceroptosis. In the former, the low position of the stomach or colon does not interfere with physiologic function; whereas, in the latter the dropped or prolapsed position of the organ results in a perversion of physiologic function which gives rise to symptoms. Therefore, visceroptosis should not be viewed from the anatomic viewpoint. When clinical symptoms arise as a result of physiologic malfunction in a visceroptotic individual in whom organic disease has been excluded, then, and then only, has visceroptosis clinical significance. Gastroptosis, often called falling or dropping of the stomach, results from a relaxation or a stretching of the mesenteric or peritoneal attachments. Clinical gastroptosis often follows where there has been emaciation and relaxation of the abdominal muscles, as well as absorption of fat from the lesser omentum and the gastrohepatic and gastrocolic ligaments. Gastroptosis is almost always acquired; some individuals inherit a constitutional predisposition toward it. The condition is more prevalent in the female, the ratio in our series being 4 to 1. The condition occurs in individuals from 20 to 70 years of age; 80 per cent of cases occur in the age period from 20 to 50. In clinical gastroptosis the stomach is usually elongated, the greater curvature being considerably below the inter-iliac line, often resting on the pelvic floor. There is often an associated atony. The cardiac portion of the stomach is never displaced downward, whereas the pyloric portion often occupies a level below the normal.