Gastric volvulus in children

Introduction: Acute gastric volvulus in infants and children is known as a rare but life-threatening emergency that requires prompt recognition and treatment. It may also present as subacute or chronic problem may be under diagnosed. Gastric volvulus is defined as torsion of more than 180 grade of the stomach around itself. The first description was made in 1866 by Berti. Three types of gastric volvulus have been described: organoaxial, mesentericoaxial and the combination of the both.

Case report: Over the 15-year period one patient was admitted with an acute gastric volvulus and operated in Pediatric Surgery of the Heim Pal Children's Hospital and has been controlled examination in the Pediatric Children's Hospital of St. John's Hospital. The 8 years old boy had had upper abdominal distension and pain, vomiting, hematemesis. Diagnosis was done by ultrasonography and acute upper endoscopy. Endoscopic examination showed narrowed cardia above of the gastric volvulus and bleeding from the stomach into the esophagus. A midline laparatomy was used. Had been founded organo-axial gastric volvulus. The surgical procedures involved phrenofundopexy, anterior gastropexy, gastrostomy, jejunostomy because of earlier enteral feeding. Gastrophrenic, gastrosplenic and gastrocolic ligament laxaty can be defined. One month later Heinicke-Mikulitz surgery was made due to pyloric stenose as a consequence of ischemia. He had been severe esophagitis and gastritis initially. The follow up endoscopic examination detected the cure of esophagitis and ulcerative gastritis. After surgery he received antibiotic, antacids and prokinetic drugs. The control contrast X-ray examination has not found GER or recurrent pyloric stenose. He has been well, but has ate little portion several times. Conclusion: Gastric volvulus is a clinical emergency which can be life-threatening for children. Prompt diagnosis of major importance to avoid any further complication as seen in the acute form of the disease. Gastropexy is the key to definitive treatment.