Gastric volvulus in children: the twists and turns of an unusual entity

Abstract

A spectrum of findings in gastric volvulus exists. Mesenteroaxial volvulus has greater morbidity and mortality. Radiographic findings of spherical gastric dilatation, paucity of distal gas and diaphragmatic elevation are suggestive of acute volvulus, particularly in patients with predisposing factors.

Usual and unusual causes of pediatric gastric outlet obstruction

“…Borchardt's triad of nonproductive vomiting, pain and inability to pass an enteric tube is seen in 70% of patients [26,28]. Gastric volvulus is often associated with other congenital abnormalities, including diaphragmatic or hiatal hernias, diaphragmatic eventration and intestinal malrotation [27,28,30,31]. Definitive treatment is surgical derotation with repair of associated defects as needed, and possible gastropexy [29,30].…”

“…Definitive treatment is surgical derotation with repair of associated defects as needed, and possible gastropexy [29,30]. Nonsurgical management has been reported with some success [27,31,32].…”

Acute mesenteroaxial gastric volvulus on computed tomography

“…[7] One of the predisposing factors for volvulus is the presence of a diaphragmatic defect; in adults, organoaxial volvulus occurs commonly in the setting of a post-traumatic diaphragmatic defect or a para-oesophageal hernia. [1,6] Another predisposing factor for volvulus is the presence of an abnormality relating to the anchoring of the stomach and the surrounding ligaments.…”

“…The greater and lesser curvatures are in their usual positions relative to each other. [7] There is reversal of the relationship of the GO junction and pylorus, and they may lie in close…”

“…[3,5,6] Mesenteroaxial and the combined type tend to present acutely. [3,7] Imaging Gastric volvulus may have a nonspecific clinical presentation, hence increasing the reliance on imaging to assist in coming to the correct diagnosis. It is also imperative that, in the acute setting, imaging studies do not result in delays in coming to a diagnosis and subsequent management.…”