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Yang Z, Xie X, Wang S, Pei G, Zhan J. An acute gastric volvulus in a child with congenital left diaphragmatic hernia: a case report. BMC Pediatr 2024; 24:348. [PMID: 38769486 PMCID: PMC11103888 DOI: 10.1186/s12887-024-04834-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 05/14/2024] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND Acute complete gastric volvulus is a rare and life-threatening disease, which is prone to gastric wall ischemia, perforation, and necrosis. If it is not treated by surgery in time, the mortality rate can range from 30 to 50%. Clinical presentations of acute gastric volvulus are atypical and often mimic other abdominal conditions such as gastritis, gastroesophageal reflux, gastric dilation, and pancreatitis. Imaging studies are crucial for diagnosis, with barium meal fluoroscopy being the primary modality for diagnosing gastric volvulus. Cases of acute gastric volvulus diagnosed by ultrasound are rarely reported. CASE PRESENTATION We reported a rare case of acute gastric volvulus in a 4-year-old Chinese girl who presented with vomiting and abdominal pain. Ultrasound examination revealed the "whirlpool sign" in the cardia region, raising suspicion of gastric volvulus. Diagnosis was confirmed by X-ray barium meal fluoroscopy, which indicated left-sided diaphragmatic hernia and obstruction at the cardia region. Surgical intervention confirmed our suspicion of acute complete gastric volvulus combined with diaphragmatic hernia. CONCLUSION In this case, we reported an instance of acute complete gastric volvulus. Ultrasound revealed a "whirlpool sign" in the cardia, which is likely to be a key sign for the diagnosis of complete gastric volvulus.
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Affiliation(s)
- Zesheng Yang
- Tianjin Children's Hospital (Children's Hospital of Tianjin University), Tianjin, China.
- Department of Ultrasound, Tianjin Children's Hospital (Children's Hospital of Tianjin University), No.238 Longyan Road, Beichen District, Tianjin, 300134, China.
| | - Xiaoying Xie
- Tianjin Children's Hospital (Children's Hospital of Tianjin University), Tianjin, China
- Department of Ultrasound, Tianjin Children's Hospital (Children's Hospital of Tianjin University), No.238 Longyan Road, Beichen District, Tianjin, 300134, China
| | - Shicheng Wang
- Tianjin Children's Hospital (Children's Hospital of Tianjin University), Tianjin, China
- Department of Ultrasound, Tianjin Children's Hospital (Children's Hospital of Tianjin University), No.238 Longyan Road, Beichen District, Tianjin, 300134, China
| | - Guanghua Pei
- Tianjin Children's Hospital (Children's Hospital of Tianjin University), Tianjin, China.
- Department of Ultrasound, Tianjin Children's Hospital (Children's Hospital of Tianjin University), No.238 Longyan Road, Beichen District, Tianjin, 300134, China.
| | - Jianghua Zhan
- Tianjin Children's Hospital (Children's Hospital of Tianjin University), Tianjin, China
- Department of General Surgery, Tianjin Children's Hospital(Children's Hospital of Tianjin University), Tianjin, China
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Ueshima M. Acute gastric volvulus mimicking features of gastroenteritis in a 5-year-old girl. Clin Case Rep 2024; 12:e8549. [PMID: 38435501 PMCID: PMC10901780 DOI: 10.1002/ccr3.8549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 11/28/2023] [Accepted: 01/21/2024] [Indexed: 03/05/2024] Open
Abstract
Acute gastric volvulus is a life-threatening condition. Especially, a history of adjacent organ deformities in children with intermittent vomiting and abdominal pain should suggest gastric volvulus, even if the symptoms resemble gastroenteritis.
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Affiliation(s)
- Manami Ueshima
- Department of PediatricsKameda Medical CenterKamogawaChibaJapan
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Kumar S, Saxena R, Kumar R, Chauhan S, Diwakar K. Congenital Diaphragmatic Hernia With Intra Thoracic Gastric Volvulus: A Rare, Life-Threatening Combination. Cureus 2023; 15:e38354. [PMID: 37266051 PMCID: PMC10229446 DOI: 10.7759/cureus.38354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2023] [Indexed: 06/03/2023] Open
Abstract
Congenital diaphragmatic hernia (CDH) is a known cause of secondary gastric volvulus (GV). Both entities are life-threatening, either alone or in exceedingly rare instances when they occur in combination. Here, we describe one such rare combination of CDH and secondary GV in a nine-year-old boy, who presented to us with recurrent episodes of abdominal pain. Urgent laparotomy was done after radiological evaluation (X-ray of chest and abdomen and contrast-enhanced CT chest and abdomen), which revealed mesenterico-axial volvulus of the stomach, secondary to an underlying diaphragmatic defect in the left hemidiaphragm, thus establishing the cause (diaphragmatic defect) and effect (GV), and resulting in a favourable outcome.
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Affiliation(s)
- Shishir Kumar
- Department of Surgery, Tata Main Hospital, Jamshedpur, IND
| | - Rahul Saxena
- Department of Surgery, Tata Main Hospital, Jamshedpur, IND
| | - Ranjan Kumar
- Department of Surgery, Manipal Tata Medical College, Jamshedpur, IND
| | | | - Kumar Diwakar
- Department of Pediatrics, Tata Main Hospital, Jamshedpur, IND
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Kawahara M, Maruyama T, Kaneko Y, Konno N, Kashimura H, Oda T. Mesentero-axial gastric volvulus treated with laparoscopic gastropexy: a case report. Surg Case Rep 2023; 9:20. [PMID: 36757547 PMCID: PMC9911570 DOI: 10.1186/s40792-023-01596-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 01/23/2023] [Indexed: 02/10/2023] Open
Abstract
BACKGROUND Mesentero-axial gastric volvulus (MAGV) is an uncommon subtype of gastric volvulus (GV). However, reports of such cases in adult patients are very rare. We present an unusual case of idiopathic MAGV in an old woman. CASE PRESENTATION An 84-year-old woman was referred to the emergency department for vomiting and abdominal pain. An abdominal computed tomography scan revealed a mesentero-axial gastric volvulus, which could be corrected endoscopically, and the symptoms were relieved. Contrast-enhanced examination was performed before the elective surgery to confirm the presence of short-axis dorsal 180-degree volvulus. The patient underwent laparoscopic surgery on a wait-and-watch basis. After releasing the torsion, the stomach returned to normal position. The gastric fornix was sutured to the left diaphragm and the gastric body and antrum were sutured to the abdominal wall using non-absorbable thread. Symptoms did not flare after the surgery. CONCLUSIONS We experienced a rare case of adult MAGV presenting with incomplete obstruction. Laparoscopic gastropexy is useful when gastric decompression is achieved.
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Affiliation(s)
- Masato Kawahara
- Department of Surgery, Mito Saiseikai General Hospital, 3-3-10, Futabadai, Mito City, Ibaraki, 311-4198, Japan.
| | - Tsunehiko Maruyama
- grid.415975.b0000 0004 0604 6886Department of Surgery, Mito Saiseikai General Hospital, 3-3-10, Futabadai, Mito City, Ibaraki 311-4198 Japan
| | - Yoshiki Kaneko
- grid.415975.b0000 0004 0604 6886Department of Surgery, Mito Saiseikai General Hospital, 3-3-10, Futabadai, Mito City, Ibaraki 311-4198 Japan
| | - Naoaki Konno
- grid.415975.b0000 0004 0604 6886Department of Gastroenterology, Mito Saiseikai General Hospital, 3-3-10, Futabadai, Mito City, Ibaraki 311-4198 Japan
| | - Hiroshi Kashimura
- grid.415975.b0000 0004 0604 6886Department of Gastroenterology, Mito Saiseikai General Hospital, 3-3-10, Futabadai, Mito City, Ibaraki 311-4198 Japan
| | - Tatsuya Oda
- grid.20515.330000 0001 2369 4728Department of Gastroenterological Surgery, University of Tsukuba, 1-1-1, Tennodai, Tsukuba City, Ibaraki 305-8577 Japan
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Gastric volvulus in the mediastinum through a hiatal hernia. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2022. [DOI: 10.1016/j.epsc.2022.102426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Iacona RV, Grasso F, Grimaldi SA, Lebet M, Cacciaguerra S. Laparoscopic Assisted Percutaneous Anterior Gastropexy for the Management of Acute and Chronic Gastric Volvulus in Infants. CHILDREN 2022; 9:children9091275. [PMID: 36138584 PMCID: PMC9497062 DOI: 10.3390/children9091275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 08/05/2022] [Accepted: 08/15/2022] [Indexed: 11/16/2022]
Abstract
Acute and chronic gastric volvulus (ACGV) is a rare event in infants and children. Its prompt treatment is needed to avoid gastric ischemia and perforation. A laparotomy or a laparoscopic/endoscopic reduction with or without the gastrostomy formation has been described to treat this condition. We wanted to report our experience and describe the surgical technique used to perform the percutaneous laparoscopic assisted anterior gastropexy in neonates presenting with this condition. We perform a retrospective review of a single institution’s experience with laparoscopic assisted percutaneous anterior gastropexy over a seven-year period (2015–2022). Procedures were performed under general anesthesia and the anterior gastropexy was performed using a modified extracorporeal knotting technique as described for the laparoscopic assisted repair of inguinal hernias via percutaneous internal ring suturing. Thirteen patients underwent surgery for ACGV at our institution over a seven-year period. The median age at diagnosis was 57 days, 7/13 patients presented with acute vomiting and regurgitation (54%), 1/13 (8%) presented with mainly feeding difficulties and 1/13 (8%) presented with acute abdominal distension. Data were not available for 4/13 patients. All of the patients underwent laparoscopic assisted anterior gastropexy using extracorporeal knotting technique; no gastrostomy insertion was needed. The median operative time was 50 min (40–95 min). No intraoperative complications were reported. Post-operatively patients were started on feeds on day 3 (2–5 days). Only one patient (8%) developed a postoperative complication: subcutaneous granuloma at the extracorporeal knot site. Although rare, acute GV is an important cause of gastric outlet obstruction with a detrimental outcome if not promptly recognized and treated. Laparoscopic assisted percutaneous anterior gastropexy is an attractive and safe alternative for the management of this condition in both infants and older children. This technique does not require gastrostomy placement and it has a very low morbidity rate with no mortality reported.
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Hara T, Iwama I, Hosokawa T, Nambu R. Successful Endoscopic Reduction of Gastric Volvulus in 2 Children: Acute and Chronic Cases. J Pediatr Gastroenterol Nutr 2022; 75:e30. [PMID: 35869904 DOI: 10.1097/mpg.0000000000003432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
| | | | - Takahiro Hosokawa
- the Division of Radiology, Saitama Children's Medical Center, Saitama, Japan
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Yeh PJ, Lo WC, Chen JC. Gastric volvulus presented with an upside-down stomach. Pediatr Neonatol 2022; 63:422-423. [PMID: 35307303 DOI: 10.1016/j.pedneo.2021.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 11/14/2021] [Accepted: 11/26/2021] [Indexed: 10/19/2022] Open
Affiliation(s)
- Pai-Jui Yeh
- Division of Gastroenterology, Department of Pediatrics, Chang Gung Children's Hospital, College of Medicine, Chang Gung University, Taoyuan, 333, Taiwan
| | - Wan-Chak Lo
- Department of Medical Imaging and Intervention, Chang Gung Children's Hospital, College of Medicine, Chang Gung University, Taoyuan, 333, Taiwan
| | - Jeng-Chang Chen
- Department of Surgery, Chang Gung Children's Hospital, College of Medicine, Chang Gung University, Taoyuan, 333, Taiwan.
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Chiarenza SF, Zolpi E, Costa L, Cocco P, Conighi ML, Bleve C. Pediatric Gastric Volvulus: Is Laparoscopic Hill-Snow-Modified Gastropexy the Effective Long-Term Minimally Invasive Solution? J Laparoendosc Adv Surg Tech A 2022; 32:913-919. [PMID: 35666597 DOI: 10.1089/lap.2021.0836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction: Gastric volvulus (GV) is a rare and life-threatening condition if not promptly diagnosed and treated. Extreme rotation can cause obstruction cutting off blood supply to stomach and distal organs, leading to ischemia and necrosis. It is a clinically significant cause of acute/recurrent abdominal pain and chronic vomiting in children. GV can be classified into the following: primary, secondary, organoaxial, mesenteroaxial, or combined, acute, or chronic. Materials and Methods: Six neonates (5 males-1 female) were admitted to our department for recurrent postprandial vomiting associated with paleness, hyporeactivity, transitory abdominal distension, failure to thrive, and respiratory infections (only-1). Median age: 6 months (range 2-9 months). Patients metabolic and neurological evaluations were normal. A barium-swallow-study (upper gastrointestinal [UGI]) allowed definitive diagnosis. Results: UGI and esophagogastroduodenoscopy (EGDS) showed a gastric abnormal dilatation (gastric fundus), hiatal hernia (HH) in 5 patients, a large/small curvature discrepancy in 3 patients. Four were chronic-organoaxial-GV, 2 chronic-mesenteroaxial-GV. All underwent Laparoscopic-Hill-Snow-gastropexy (LHSG) with HH correction. No intraoperative/postoperative complications were recorded. Refeeding started in first postoperative day. Average hospital stay: 6-days. At long-term follow-up, all patients were symptoms free (able to vomit/burp); 2 referred occasionally epigastric pain sometimes with vomit. At 10-12 years follow-up UGI and EGDS confirmed correct gastric position revealing gastroduedenitis. Discussion: GV is a rare clinical entity in children considering etiology and management with an important morbidity and mortality rate. Its diagnosis could be missed simply. Vomiting or HH on imaging studies should suggest GV regardless patient's stable appearance. Conclusions: Chronic GV can manifest with atypical chest, abdominal, and gastrointestinal symptoms. Early diagnosis and treatment reduce the risk of developing acute form. LHSG is a long-term effective and safe solution with a very low complication rate, and no symptoms correlated to Nissen procedure.
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Affiliation(s)
- Salvatore Fabio Chiarenza
- Department of Pediatric Surgery and Pediatric Minimally Invasive Surgery and New Technologies, San Bortolo Hospital, Vicenza, Italy
| | - Elisa Zolpi
- Department of Pediatric Surgery and Pediatric Minimally Invasive Surgery and New Technologies, San Bortolo Hospital, Vicenza, Italy
| | - Lorenzo Costa
- Department of Pediatric Surgery and Pediatric Minimally Invasive Surgery and New Technologies, San Bortolo Hospital, Vicenza, Italy
| | - Paolo Cocco
- Department of Pediatric Surgery and Pediatric Minimally Invasive Surgery and New Technologies, San Bortolo Hospital, Vicenza, Italy
| | - Maria Luisa Conighi
- Department of Pediatric Surgery and Pediatric Minimally Invasive Surgery and New Technologies, San Bortolo Hospital, Vicenza, Italy
| | - Cosimo Bleve
- Department of Pediatric Surgery and Pediatric Minimally Invasive Surgery and New Technologies, San Bortolo Hospital, Vicenza, Italy
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Trombetta A, Cozzi G, Pederiva F. Boy with abdominal distension and hyperamylasaemia. Emerg Med J 2022; 39:e4. [PMID: 35613738 DOI: 10.1136/emermed-2021-211151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2021] [Indexed: 11/04/2022]
Affiliation(s)
| | - Giorgio Cozzi
- Pediatric Emergency Department, Institute for Maternal and Child Health-IRCCS Burlo Garofolo, Trieste, Italy
| | - Federica Pederiva
- Pediatric Surgery, Burlo Garofalo Pediatric Institute, Trieste, Italy
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Cianci MC, Coletta R, Morabito A. Let's (Not) Twist Again: Laparoscopic-Assisted Percutaneous Endoscopic Gastrostomy in Paediatric Gastric Volvulus. Dig Dis Sci 2021; 66:2533-2536. [PMID: 34097169 DOI: 10.1007/s10620-021-07071-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/20/2021] [Indexed: 12/09/2022]
Abstract
INTRODUCTION In the setting of intermittent abdominal pain accompanied by gastro-intestinal obstruction, gastric volvulus should be suspected. AREAS COVERED A 10-year-old girl was admitted to our hospital for intermitted abdominal pain associated with recurrent non-bilious vomiting and acute weight loss. The radiological images performed at the district general hospital were reported as negative. After careful review of the imaging, a gastric volvulus was suspected. Exploratory laparoscopy confirmed the diagnosis; laparoscopic-assisted percutaneous endoscopic gastrostomy was performed. The postoperative upper gastro-intestinal study showed stomach in its normal shape and position. EXPERT COMMENTARY Gastric volvulus is a potential life-threatening condition with a good outcome when promptly recognized. Laparoscopic-assisted percutaneous endoscopic gastrostomy is a safe and curative procedure in the case of suspected gastric volvulus, avoiding the need for a secondary procedure. In pediatric patients, it facilitates direct inspection of the stomach and abdominal cavity, reducing the need for a second procedure. This procedure may emerge as a 'gold standard' for gastric volvulus treatment.
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Affiliation(s)
- Maria Chiara Cianci
- Department of Paediatric Surgery, Meyer Children's Hospital, University of Florence, Viale Pieraccini 24, 50139, Florence, Italy
| | - Riccardo Coletta
- Department of Paediatric Surgery, Meyer Children's Hospital, University of Florence, Viale Pieraccini 24, 50139, Florence, Italy. .,School of Environment and Life Science, University of Salford, Salford, UK.
| | - Antonino Morabito
- Department of Paediatric Surgery, Meyer Children's Hospital, University of Florence, Viale Pieraccini 24, 50139, Florence, Italy.,Dipartimento di Neuroscienze, Psicologia, Area del Farmaco e della Salute del Bambino NEUROFARBA, University of Florence, Viale Pieraccini 6, 50121, Florence, Italy
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Kim MY, Park MS, Lee JH. Two Cases of Gastric Volvulus in Neonates. NEONATAL MEDICINE 2021. [DOI: 10.5385/nm.2021.28.1.36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Mistry V, Gamble EL, Chang J. Adult mesentero-axial gastric volvulus: Case report. J Med Imaging Radiat Oncol 2020; 64:817-820. [PMID: 32441440 DOI: 10.1111/1754-9485.13051] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 04/27/2020] [Indexed: 11/30/2022]
Abstract
Acute gastric volvulus is a rare surgical emergency which can lead to severe complications such as gastric ischaemia and perforation. Gastric volvulus is classified by the axis upon which the stomach rotates into organo-axial and mesentero-axial subtypes, with the former more common in adults. We present an uncommon case of recurrent adult mesentero-axial gastric volvulus and describe the associated radiological findings.
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Affiliation(s)
- Vijay Mistry
- Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Erin Lee Gamble
- Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Jennifer Chang
- Princess Alexandra Hospital, Brisbane, Queensland, Australia
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