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A Case of an Upside-Down Stomach

Shaoul, R MD*; Toubi, A MD

Journal of Pediatric Gastroenterology & Nutrition: November 2006 - Volume 43 - Issue 5 - p 698
doi: 10.1097/01.mpg.0000221893.66995.09
Case Reports

*Departments of Pediatrics

Radiology, Faculty of Medicine, Bnai Zion Medical Center, Technion, Haifa, Israel

Received 22 October, 2005

Accepted 6 February, 2006

Address correspondence and reprint requests to Ron Shaoul, MD, Bnai Zion Medical Center, Israel (e-mail:

A 6-week-old infant was admitted to our pediatric department for anorexia and failure to thrive. He was born at term after uneventful pregnancy and delivery. Birth weight was 3.380 kg. From birth, he was noted to have poor appetite and he failed to gain weight. On the 2 days before admission, he appeared to be distressed during feedings. Physical examination revealed a cachectic, tachypneic, but no respiratory distress was evident. His weight was 3.6 kg; clinical examination of the lungs was normal as was the rest of the physical examination. Chest x-ray showed an eventration of the left diaphragm. Abdominal ultrasound showed normal movement of the left diaphragm. A barium study showed an organoaxial volvulus of the stomach (Figure) and confirmed normal location of the Treitz ligament.

The stomach is normally fixed inferiorly by the duodenum, and its usual configuration is maintained by the gastrosplenic, gastroduodenal, gastrophrenic, and gastrohepatic ligaments. Ligamentous laxity, pyloric obstruction, diaphragmatic hernias, eventration of diaphragm and adhesions serve as predisposing factors for volvulus of the stomach. Approximately 15% to 20% of cases of gastric volvulus occur in children, usually under 1 year of age. It is frequently associated with a congenital diaphragmatic defect. The more common variation is an organoaxial gastric volvulus, in which the stomach twists on its long axis. The clinical symptoms depend on the extent or degree of rotation and obstruction. Indications for surgical intervention are determined by evidence of vascular compromise. Anterior gastropexy with a gastrostomy is the procedure of choice. Percutaneous gastrostomy using anchoring devices and laparoscopic-guided gastropexy have been reported.3

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© 2006 Lippincott Williams & Wilkins, Inc.