This rare complication of weight loss surgery can lead to symptoms like nausea, vomiting, pain, and reflux, or have no symptoms at all.

A twisted stomach, or gastric twist, can sometimes happen after gastric sleeve weight loss surgery. It’s not very common and is estimated to affect only 0.69% to 2% of people after surgery. But when it does happen, it can cause vomiting, nausea, pain, or reflux.

Because several conditions could cause these symptoms, or there may be none at all, doctors can have difficulty diagnosing a twisted stomach. But it can lead to serious complications if not caught early.

Here’s what a twisted stomach is, why it happens, and what you can do about it.

Doctors perform gastric sleeve surgery to help people with obesity safely lose weight. During the procedure, doctors remove nearly all of your stomach, including the part that makes you hungry. The remainder is a banana- or sleeve-shaped tube that doctors close with staples.

Because your stomach is much smaller and sends fewer hunger signals, people usually eat less and lose weight after the surgery.

Sometimes, days, weeks, or even a year after the surgery, the tube-shaped remainder of your stomach can rotate or become twisted. The twist can block food and blood from moving through your stomach.

A 2022 study of 2,723 people who had gastric sleeve surgery found that only 1.6% experienced a gastric twist. Most had no symptoms relating to the twist. Of those that did, symptoms were usually mild. Vomiting was the most common.

It can be hard to diagnose at first because gastric twist symptoms aren’t very specific. However, a twisted stomach can lead to serious complications. The sooner you catch it, the easier it will be to treat.

A twisted stomach differs from Dumping syndrome, although gastric surgery can cause both.

Dumping syndrome happens when food moves too quickly from your stomach into your small intestine. A twisted stomach, meanwhile, prevents food from moving through your stomach into your small intestine.

You may have symptoms of Dumping syndrome within just a few minutes of eating a meal or 1 to 3 hours after a high-carbohydrate meal. Your symptoms are similar to a twisted stomach. They can include:

  • cramps
  • burping
  • upset stomach
  • diarrhea
  • throwing up

Most of the time, you’ll be able to avoid Dumping syndrome by:

  • eating smaller, more frequent meals
  • waiting for 30 minutes after a meal before drinking water or other beverages
  • avoiding sugar or milk products
  • eating more foods with protein and fat and less with carbohydrates

Gastric twist often doesn’t have any symptoms. But when you do have symptoms, they may include:

  • vomiting
  • nausea
  • difficulty swallowing
  • pain
  • reflux

It’s not always clear what creates a gastric twist after surgery.

Researchers think it may be caused by:

  • disruption of the ligaments that support the stomach during surgery
  • unequal traction on the different sides of your stomach when surgeons are applying staples
  • swelling
  • hematomas (collection of blood outside a blood vessel)
  • incorrect staple placement during surgery

Most people stay in the hospital for 1 to 3 days after weight loss surgery. Returning to normal activities usually takes between 4 to six weeks.

Although a gastric twist may not cause any symptoms at first, it can become a potentially serious complication of gastric sleeve surgery. Depending on how badly your stomach is twisted or rotated, it could block blood and nutrient flow.

It’s essential to treat it as soon as possible to improve outcomes.

Doctors can best treat a twisted stomach by catching it early and using endoscopy and laparoscopic surgery. Endoscopy is usually the first line of treatment.

Other ways to treat it include:

A twisted stomach is a rare complication of gastric sleeve surgery. A twisted stomach can happen after a gastric sleeve for several reasons, including problems during the surgery.

Twisted stomach symptoms, such as nausea and vomiting, don’t always point to the problem, so it can be hard to diagnose. Doctors have a variety of ways to treat it, but it’s essential to catch it as soon as possible for the best outcome.