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Long B, Easter J, Koyfman A. High risk and low incidence diseases: Pediatric digestive volvulus. Am J Emerg Med 2024; 82:153-160. [PMID: 38908340 DOI: 10.1016/j.ajem.2024.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 06/10/2024] [Accepted: 06/12/2024] [Indexed: 06/24/2024] Open
Abstract
INTRODUCTION Pediatric digestive volvulus is a serious condition that carries with it a high rate of morbidity and mortality. OBJECTIVE This review highlights the pearls and pitfalls of pediatric digestive volvulus, including the presentation, diagnosis, and management in the emergency department (ED) based on current evidence. DISCUSSION Pediatric digestive volvulus is a deadly condition most commonly associated with malrotation. It occurs when the stomach or small intestine twists on itself, resulting in ischemia and potentially strangulation with necrosis and perforation. Presentation differs based on the gastrointestinal (GI) segment affected, degree of twisting, and acuity of the volvulus. Gastric volvulus most commonly presents with retching with or without nonbilious emesis and epigastric distension with pain, while midgut volvulus typically presents with bilious emesis in infants. Patients with GI necrosis and perforation may present with hemodynamic compromise and peritonitis. If suspected, emergent consultation with the pediatric surgery specialist is necessary, and if this is not available, transfer to a center with a pediatric surgeon is recommended. Imaging includes plain radiography, ultrasound, or upper GI series, while treatment includes resuscitation, administration of antibiotics, and emergent surgical decompression and detorsion of the involved segments. CONCLUSION An understanding of pediatric digestive volvulus and its many potential mimics can assist emergency clinicians in diagnosing and managing this deadly disease.
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Affiliation(s)
- Brit Long
- Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, TX, USA.
| | - Joshua Easter
- Department of Emergency Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Alex Koyfman
- Department of Emergency Medicine, UT Southwestern, Dallas, TX, USA
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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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Pungwe P, Ukwade D, Patel A, Ajayi TA, Ketwaroo G. Endoscopic Reduction of an Acute Gastric Volvulus. Cureus 2024; 16:e58198. [PMID: 38741858 PMCID: PMC11090073 DOI: 10.7759/cureus.58198] [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: 04/11/2024] [Indexed: 05/16/2024] Open
Abstract
We are reporting a case of gastric volvulus in a 52-year-old man in the setting of a paraesophageal hernia initially identified on computerized tomography (CT). CT of the abdomen showed a large paraesophageal hernia with intra-thoracic herniation of the distal stomach and gastroduodenal junction, resulting in mesenteroaxial rotation consistent with acute gastric volvulus. Esophagogastroduodenoscopy (EGD) confirmed the presence of the gastric volvulus, which was initially temporized with endoscopic detorsion. He subsequently had nasogastric tube placement and ultimately underwent a laparoscopic gastropexy. He recovered uneventfully with plans for Roux-en-Y gastric bypass surgery.
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Affiliation(s)
- Prisca Pungwe
- Internal Medicine, Baylor College of Medicine, Houston, USA
| | - Dirin Ukwade
- Internal Medicine, University of Illinois Chicago, Chicago, USA
| | - Ankur Patel
- Internal Medicine, Baylor College of Medicine, Houston, USA
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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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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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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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Tada Y, Orihara J, Wada Y, Uchinaka E, Osaki T, Ashida K, Tatebe S, Kuroda S, Hirooka Y. Post-colostomy internal hernia of the stomach treated with laparoscopic gastropexy: a case report. Surg Case Rep 2022; 8:105. [PMID: 35644826 PMCID: PMC9148867 DOI: 10.1186/s40792-022-01455-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 05/15/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Internal hernias are formed by the protrusion of internal organs through an aperture formed congenitally or postoperatively. Internal hernias are most commonly associated with the small intestine. Only two cases of a post-sigmoid colostomy internal hernia of the stomach have been reported. This hernia arises from the space between the lifted sigmoid colon and the left abdominal wall. In the two aforementioned cases, treatment comprised suturing of the sigmoid colon to the lateral abdominal wall and changing of the intraperitoneal route to an extraperitoneal one. Herein, we present a very rare case who underwent laparoscopic gastropexy for a post-sigmoid colostomy internal hernia of the stomach.
Case presentation
Our patient, a 67-year-old woman, was undergoing chemoradiation for rectal cancer and planned to undergo abdominoperineal resection. However, tumor perforation resulted in a high fever and a right gluteal abscess; therefore, a sigmoid colostomy was performed through the intraperitoneal route in the left lower abdomen. One month after the surgery, the patient presented to our emergency room with vomiting, abdominal pain, and abdominal distension. Computed tomography revealed a markedly distended stomach caused by the obstruction of the pylorus secondary to the colostomy; laparoscopic gastropexy was performed subsequently and the postoperative course was uneventful.
Conclusions
This is the first report on the laparoscopic gastropexy treatment of a post-sigmoid colostomy internal hernia of the stomach; our findings may help physicians manage such hernias.
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