Infants with radiologic diagnosis of gastric volvulus: are they over-treated?

Abstract

Gastric volvulus (GV) is a rare condition in infants. The aim of this study was to define the management strategies of infants with GV based on their clinical and radiologic features. The medical records of 13 infants with a radiologically confirmed diagnosis of GV were retrospectively reviewed. Patients were divided into two groups according to the type of treatment (surgical vs conservative). Abdominal radiographs and upper gastrointestinal contrast studies allowed an unequivocal diagnosis in both groups. Group 1 included 3 infants with acute GV and 2 with chronic, intermittent secondary GV. Three patients had associated diaphragmatic defects, 1 had an ileocolic intussusception, and 1 had hypertrophic pyloric stenosis. The main presenting symptoms were vomiting, dehydration, respiratory distress, and abdominal pain and distention in acute cases and vomiting and failure to thrive in chronic cases. A laparotomy was required in all 5 infants with no recurrence of symptoms. Group 2 included 8 infants with idiopathic chronic GV, who were managed nonoperatively with gradual improvement of symptoms over 12 months. Based on our study, we conclude that: (1) laparotomy can be reserved for patients with either acute or chronic secondary GV; (2) conservative treatment is both safe and effective in infants with chronic idiopathic GV; and (3) routine gastropexy for all patients with a radiologic diagnosis of GV appears to be overtreatment.

Acute and chronic gastric volvulus in infants and children: who should be treated surgically?

“…This conservative approach proved to be effective in 11 of our patients. The surgical treatment of chronic gastric volvulus is still controversial [9]. There are those who advocate anterior gastropexy only [1].…”

Acute mesenteroaxial gastric volvulus and congenital diaphragmatic hernia

“…The abdominal radiograph may show typical signs of mesenteroaxial AGV as described by Elhalaby and Mashaly: the stomach is in a vertical position with the pylorus higher than the cardia, and a double air-fluid level is present [13]. When associated with a left diaphragmatic hernia, the antrum and pylorus are located inside the hernia, and the hooklike sign is present, as illustrated in our patient (Fig.…”

“…The diagnosis of AGV should be systematically ruled out when clinical signs of gastrointestinal obstruction are present in a patient with CDH. Elhalaby and Mashaly reported five patients with AGV, three of whom had CDH [13]. The high frequency of this association may be explained by the increased space around the stomach under the left diaphragmatic defect and by the laxity of gastrophrenic and gastrosplenic ligaments.…”

Delayed presentation of congenital diaphragmatic hernia with intrathoracic gastric volvulus

“…There was another report of 5 patients with GV, 3 of whom had congenital diaphragmatic hernia. [9][10][11] The high frequency of this association may be explained by the increased space around the stomach under the left diaphragmatic defect and by the laxity of gastrophrenic and gastrosplenic ligaments. Excessive coughing may increase intragastric pressure leading to strangulation of the stomach in a diaphragmatic defect.…”