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Gastric Volvulus

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Pediatric Surgery

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Abstract

Gastric volvulus (GV) is a rare surgical emergency, defined by the abnormal rotation of a part of the stomach around another part, leading to obstruction, and in some cases, tissue ischemia and necrosis. Anatomically, most cases are either organoaxial volvulus, occurring along the stomach’s longitudinal axis from the gastroesophageal junction to the pylorus, or mesenteroaxial volvulus, occurring perpendicular to the longitudinal axis, such that the pylorus and antrum come to lie above the gastroesophageal junction. Associated contributory diaphragmatic anomalies are common, especially in neonates, while splenic anomalies are also frequent.

GV may present as an acute or chronic condition. The mode of presentation varies depending on age. Neonates and infants may present with respiratory distress, non-bilious vomiting, excessive salivation, and regurgitation of feeds. Older children may present with Borchardt’s triad of non-productive retching, localized epigastric swelling, and failure to pass a nasogastric tube.

Diagnosis relies on index of suspicion, and is aided by plain radiography of the chest and abdomen, and upper gastrointestinal contrast series to clarify the anatomical orientation of the stomach. Suggestive plain radiography findings include spherically distended stomach with two air-fluid levels or a double retrocardiac air-fluid level, as is the case with intrathoracic GV.

In acute GV, surgery is the management of choice and involves correction of any contributory anatomical abnormalities such as diaphragmatic hernia as well as fixation of the stomach to the anterior abdominal wall with a gastrostomy and/or anterior gastropexy. Minimally invasive approaches are being more frequently employed to achieve these goals.

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References

  • Aga P, Parashari UC, Parihar A, Singh R, Kohli N. MRI in isolated dextrogastria with eventration of the right hemidiaphragm with associated mesentero-axial volvulus. Pediatr Radiol. 2010;40:1576–8.

    Article  PubMed  Google Scholar 

  • Anagnostara A, Koumanidou C, Vakaki M, Manoli E, Kakavakis K. Chronic gastric volvulus and hypertrophic pyloric stenosis in an infant. J Clin Ultrasound. 2003;31:383–6.

    Article  PubMed  Google Scholar 

  • Asch MJ, Sherman NJ. Gastric volvulus in children: report of two cases. J Pediatr Surg. 1977;12:1059–62.

    Article  CAS  PubMed  Google Scholar 

  • Bawa M, Garge S, Khanna S, Kanojia RP, Rao KL. A case of ‘an upside down stomach’. Hernia. 2012;16:489–92.

    Article  CAS  PubMed  Google Scholar 

  • Cameron BH, Blair GK. Laparoscopic-guided gastropexy for intermittent gastric volvulus. J Pediatr Surg. 1993;28:1628–9.

    Article  CAS  PubMed  Google Scholar 

  • Cameron BH, Vajarvandi V, Blair GK, Fraser GC, Murphy JJ, Stringer DA. The intermittent and variable features of gastric volvulus in childhood. Pediatr Surg Int. 1995;10:26–9.

    Article  Google Scholar 

  • Campbell JB. Neonatal gastric volvulus. AJR Am J Roentgenol. 1979;132:723–5.

    Article  CAS  PubMed  Google Scholar 

  • Chan KL, Saing H. Iatrogenic gastric volvulus during transposition for esophageal atresia: diagnosis and treatment. J Pediatr Surg. 1996;31:229–32.

    Article  CAS  PubMed  Google Scholar 

  • Chuang JH, Hsieh CS, Hueng SC, Wan Y-L. Gastric volvulus complicating left hepatic lobectomy. Pediatr Surg Int. 1993;8:255–6.

    Article  Google Scholar 

  • Cole BC, Dickinson SJ. Acute volvulus of the stomach in infants and children. Surgery. 1971;70:707–17.

    CAS  PubMed  Google Scholar 

  • Colijn AW, Kneepkens CM, Taets van Amerongen A, Ekkelkamp S. Gastric volvulus after anterior gastropexy. J Pediatr Gastroenterol Nutr. 1993;17:105–7.

    Article  CAS  PubMed  Google Scholar 

  • Cribbs RK, Gow KW, Wulkan ML. Gastric volvulus in infants and children. Pediatrics. 2008;122:e752–62.

    Article  PubMed  Google Scholar 

  • Croaker GD, Najmaldin AS. Laparoscopically assisted percutaneous endoscopic gastrostomy. Pediatr Surg Int. 1997;12:130–1.

    Article  Google Scholar 

  • Dalgaard JB. Volvulus of the stomach case report and survey. Acta Chir Scand. 1952;103:131–53.

    CAS  PubMed  Google Scholar 

  • Eek S, Hagelsteen H. Torsion of the stomach as a cause of vomiting in infancy. Lancet. 1958;1:26–8.

    Article  CAS  PubMed  Google Scholar 

  • Estevao-Costa J, Soares-Oliveira M, Correia-Pinto J, Mariz C, Carvalho JL, da Costa JE. Acute gastric volvulus secondary to a Morgagni hernia. Pediatr Surg Int. 2000;16:107–8.

    Article  CAS  PubMed  Google Scholar 

  • Fung KP, Rubin S, Scott RB. Gastric volvulus complicating Nissen fundoplication. J Pediatr Surg. 1990;25:1242–3.

    Article  CAS  PubMed  Google Scholar 

  • Garcia JA, Garcia-Fernandez M, Romance A, Sanchez JC. Wandering spleen and gastric volvulus. Pediatr Radiol. 1994;24:535–6.

    Article  CAS  PubMed  Google Scholar 

  • Garel C, Blouet M, Belloy F, Petit T, Pelage JP. Diagnosis of pediatricgastric, small-bowel and colonic volvulus. Pediatr Radiol. 2016;46(1):130–8.

    Article  PubMed  Google Scholar 

  • Gerstle JT, Chiu P, Emil S. Gastric volvulus in children: lessons learned from delayed diagnoses. Semin Pediatr Surg. 2009;18:98–103.

    Article  PubMed  Google Scholar 

  • Iko BO. Volvulus of the stomach: an African series and a review. J Natl Med Assoc. 1987;79:171–6.

    CAS  PubMed  PubMed Central  Google Scholar 

  • Joshi M, Parelkar S. Acute gastric volvulus in operated cases of tracheoesophageal fistula. J Indian Assoc Pediatr Surg. 2010;15:28–9.

    Article  PubMed  PubMed Central  Google Scholar 

  • Karabulut R, Turkyilmaz Z, Sonmez K, Karakus SC, Basaklar AC. Delayed presentation of congenital diaphragmatic hernia with intrathoracic gastric volvulus. World J Pediatr. 2009;5:226–8.

    Article  PubMed  Google Scholar 

  • Koh H, Lee JS, Park YJ, Chung KS, Kim MJ, Han SJ, et al. Gastric volvulus associated with agenesis of the left lobe of the liver in a child: a case treated by laparoscopic gastropexy. J Pediatr Surg. 2008;43:231–3.

    Article  PubMed  Google Scholar 

  • Komuro H, Matoba K, Kaneko M. Laparoscopic gastropexy for chronic gastric volvulus complicated by pathologic aerophagia in a boy. Pediatr Int. 2005;47:701–3.

    Article  PubMed  Google Scholar 

  • Kulkarni KV, Sen S, Karl S, Ravikumar VR. Acute gastric volvulus: late-onset ischemic consequences and their management. J Indian Assoc Pediatr Surg. 2011;16:148–51.

    Article  PubMed  PubMed Central  Google Scholar 

  • Lal Meena M, Jenav RK, Mandia R. Gangrenous stomach in mesentroaxial volvulus. Indian J Surg. 2011;73:78–9.

    Article  PubMed  Google Scholar 

  • Matharoo G, Kalia A, Phatak T, Bhattacharyya N. Diaphragmatic rupture with gastric volvulus after heimlich maneuver. Eur J Pediatr Surg. 2013;23:502–4.

    PubMed  Google Scholar 

  • McDevitt JB. Intrathoracic volvulus of the stomach in a newborn infant. Ir J Med Sci. 1970;3:131–5.

    Article  CAS  PubMed  Google Scholar 

  • McIntyre Jr RC, Bensard DD, Karrer FM, Hall RJ, Lilly JR. The pediatric diaphragm in acute gastric volvulus. J Am Coll Surg. 1994;178:234–8.

    PubMed  Google Scholar 

  • Menezes A, Sowerby L, Malthaner RA, Parry NG. “Gastric bascule”: an unusual form of gastric volvulus. Ann Thorac Surg. 2010;89:e15–6.

    Article  PubMed  Google Scholar 

  • Mirza B, Ijaz L, Sheikh A. Gastric volvulus in children: our experience. Indian J Gastroenterol. 2012;31:258–62.

    Article  PubMed  Google Scholar 

  • Mitsunaga M, Urushihara N, Fujimoto Y, Sakamoto K. Management of gastrointestinal malformations in children with asplenia syndrome. Nihon Geka Gakkai Zasshi. 2011;112:250–4.

    PubMed  Google Scholar 

  • Mizrahi S, Vinograd I, Schiller M. Neonatal gastric volvulus secondary to rectal atresia. Clin Pediatr (Phila). 1988;27:302–4.

    Article  CAS  Google Scholar 

  • Moreno Torres E. Estenosis per hipertrofia de piloro con volvulo gastrico. Bol Soc Valenciana Paediatr. 1968;10:231–2.

    Google Scholar 

  • Nakada K, Kawaguchi F, Wakisaka M, Nakada M, Enami T, Yamate N. Digestive tract disorders associated with asplenia/polysplenia syndrome. J Pediatr Surg. 1997;32:91–4.

    Article  CAS  PubMed  Google Scholar 

  • Odaka A, Shimomura K, Fujioka M, Inokuma S, Takada S, Yamada H, et al. Laparoscopic gastropexy for acute gastric volvulus: a case report. J Pediatr Surg. 1999;34:477–8.

    Article  CAS  PubMed  Google Scholar 

  • Oh SK, Han BK, Levin TL, Murphy R, Blitman NM, Ramos C. Gastric volvulus in children: the twists and turns of an unusual entity. Pediatr Radiol. 2008;38:297–304.

    Article  PubMed  Google Scholar 

  • Okazaki T, Ohata R, Miyano G, Lane GJ, Takahashi T, Yamataka A. Laparoscopic splenopexy and gastropexy for wandering spleen associated with gastric volvulus. Pediatr Surg Int. 2010;26:1053–5.

    Article  PubMed  Google Scholar 

  • Okoye BO, Bailey DM, Cusick EL, Spicer RD. Prophylactic gastropexy in the asplenia syndrome. Pediatr Surg Int. 1997;12:28–9.

    Article  CAS  PubMed  Google Scholar 

  • Ragavan M. Acute gastric volvulus and pancreatitis following abdominal trauma in a case of eventration of diaphragm. Trop Gastroenterol. 2010;31:341–4.

    CAS  PubMed  Google Scholar 

  • Samuel M, Burge DM, Griffiths DM. Gastric volvulus and associated gastro-oesophageal reflux. Arch Dis Child. 1995;73:462–4.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Scott RL, Felker R, Winer-Muram H, Pinstein ML. The differential retrocardiac air-fluid level: a sign of intrathoracic gastric volvulus. Can Assoc Radiol J. 1986;37:119–21.

    CAS  PubMed  Google Scholar 

  • Shah A, Shah AV. Laparoscopic gastropexy in a neonate for acute gastric volvulus. Pediatr Surg Int. 2003;19:217–9.

    CAS  PubMed  Google Scholar 

  • Sivakumar K. Diaphragmatic crural eventration. J Indian Assoc Pediatr Surg. 2008;13:18–21.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Soylu H, Wiseman NE, El-Sayed Y, Yi M, Baier RJ. Radiographic confirmation of feeding tube placement: a diagnostic tool identifying gastrointestinal anomalies. Neonatal Netw. 2013;32:89–94.

    Article  PubMed  Google Scholar 

  • Starshak RJ, Sty JR. Diaphragmatic defects with gastric volvulus in the neonate. Wis Med J. 1983;82:28–31.

    CAS  PubMed  Google Scholar 

  • Stephenson RH, Hopkins WA. Volvulus of the stomach complicating eventration of the diaphragm. Report of a case. Am J Gastroenterol. 1964;41:225–34.

    CAS  PubMed  Google Scholar 

  • Stiefel D, Willi UV, Sacher P, Schwobel MG, Stauffer UG. Pitfalls in therapy of upside-down stomach. Eur J Pediatr Surg. 2000;10:162–6.

    Article  CAS  PubMed  Google Scholar 

  • Tanner NC. Chronic and recurrent volvulus of the stomach with late results of “colonic displacement”. Am J Surg. 1968;115:505–15.

    Article  CAS  PubMed  Google Scholar 

  • Zaki SA, Dadge D, Shanbag P. Diaphragmatic hernia presenting as gastrointestinal bleeding. Indian Pediatr. 2010;47:185–7.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Our Lady’s Children’s Hospital, Crumlin, Dublin 12, Ireland

    Alan E. Mortell & David Coyle

  2. Children’s University Hospital, Temple Street, Dublin 1, Ireland

    Alan E. Mortell

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  1. Alan E. Mortell
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  2. David Coyle
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Correspondence to Alan E. Mortell .

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Editors and Affiliations

  1. Our Lady’s Children's Hospital, National Children’s Research Centre, Dublin, Ireland

    Prem Puri

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Mortell, A.E., Coyle, D. (2017). Gastric Volvulus. In: Puri, P. (eds) Pediatric Surgery. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-38482-0_61-1

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  • DOI: https://doi.org/10.1007/978-3-642-38482-0_61-1

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  • Print ISBN: 978-3-642-38482-0

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