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
1. Karande TP, Oak SN, Karmarkar SJ, et al
. Gastric volvulus in childhood. J Postgrad Med 1997; 43(2):46–47.
2. Godshall D, Mossallam U, Rosenbaum R. Gastric volvulus: case report and review of the literature. J Emerg Med
1999 September–October; 17(5):837–40.
3. Newman RM, Newman E, Kogan Z, et al
. A combined laparoscopic and endoscopic approach to acute primary gastric volvulus. J Laparoendosc Adv Surg Tech A 1997; 7(3):177–181.