Pediatric gastric volvulus: diagnostic and clinical approach

Abstract

Gastric volvulus is a significant, rare cause of non-bilious vomiting and consists of a pathological rotation of the stomach of more than 180° around the axis without obstruction of the gastrointestinal tract. A definitive diagnosis is made with upper radiological gastrointestinal studies. Treatment may be conservative or surgical with anterior and fundal gastropexy in patients with ingravescent symptoms. We describe the case of a 16-month-old female admitted to our hospital for recurrent and postprandial vomiting episodes which had started at 11 months of age. A history of gastroesophageal reflux was present until 1 year of age, in association with recurrent respiratory infections. The basic metabolic panel was normal. Barium study showed stomach rotation along a horizontal plane stomach. Esophagogastroduodenoscopy showed no mucosal alterations. The diagnosis was chronic organoaxial gastric volvulus. In our patient, the surgical procedure of gastropexy, both anterior and fundal, without fundoplication was performed. She showed good improvement after surgery, with resolution of symptoms and weight gain.

Keywords: Anterior; Chronic gastric volvulus; Postprandial vomiting; fundal gastropexy.

Fig. 1

Chronic organoaxial volvulus. Barium study shows inversion of the greater (arrow) and lesser curvatures (asterisk) of the stomach and gastric rotation along a horizontal plane.

Fig. 2

Chronic organoaxial volvulus. Barium study shows marked distension of the stomach in the lateral view (arrow).