Chronic intrathoracic gastric volvulus

Abstract

Picture stories We report an infant with chronic intrathoracic mesenteroaxial gastric volvulus in whom the diagnosis was delayed for several months. This case highlights the need for considering this entity in infants and young children with recurrent vomiting. Case report A one year old boy presented with recurrent, episodic, non-bilious vomiting and severe growth failure starting at age three months when exclusively breast fed. Vomiting lasted one to two days and was accompanied by crying, irritability and poor feeding without fever, constipation or diarrhoea. In between episodes he was well. Urinary infection, metabolic, renal or hepatic dysfunction and malrotation had been excluded. He was emaciated and dehydrated. Head circumference, skin colour and genitalia were normal. There was no organomegaly or developmental delay. Chest X ray showed an elevated left hemi diaphragm (Figure 1). Upper gastrointestinal contrast study showed the stomach herniated into thorax and placed upside down. Pylorus, antrum and distal body were situated superior to cardia with partial obstruction of duodenum (Figure 2).