Gastric volvulus in children

GV is defined as a pathological rotation of the stomach. While acute GV is clinically more evident, with severe epigastric pain and vomiting, or respiratory distress, chronic GV can be much more subtle, presenting with nonspecific symptoms such as gastroesophageal reflux, respiratory infection, recurrent abdominal pain, varying from vague to severe, or just with feeding difficulties associated to epigastric distention, with or without nausea and vomiting. Clinical diagnosis of chronic GV is often difficult, due to the variety of clinical presentations, and, especially, submitted to the correct interpretation of radiological findings. Cribbs et al. [7] reported a large series of GV in England. The group with acute GV, 69 %, had pathological anomalies (diaphragmatic eventration, intestinal malrotation, and so on). Nonbilious vomiting was the most common presenting symptom of the group with chronic GV. In this casistic, overall 40 % of the patients with chronic GW were treated without surgical intervention. In the past decades, GV has been diagnosed by means of plain radiography [8]. Plain radiography findings, suggestive for GV, included the double bubble sign, abnormal gastric distension despite the presence of a nasogastric tube, a distended stomach lying in a horizontal plane, and a fluid level projecting into the epigastric region [9]. The “double bubble sign”, due to the appearance of two overlapping spherical images in the epigastrium, with elevation of the left hemidiaphragm, clearly displayed on conventional abdomen and chest X-ray, may indicate GV: diagnostic confirmation with a barium meal is usually required. A contrast study (upper gastrointestinal [UGI]) was helpful in confirming the diagnosis of chronic organoaxial gastric volvulus. Another modality of evaluating patients with these clinical signs/symptoms is a computed tomography (CT) scan that can delineate their anatomy much more clearly to avoid a delay in diagnosis that can lead to a life-threatening situation [10]. Both studies have the disadvantage of utilizing ionizing radiation, however obtaining the correct diagnosis in the most effective and efficient manner possible is crucial. Both studies can be used to make the diagnosis, and discussion with the radiologist is encouraged. Together, you can determine the best diagnostic maneuver at your institution and care can be individualized [11]. The mortality rate for acute GV is more than twice in comparison with chronic GV. The possibility of ischemia and perforation is the higher risk in acute gastric volvulus with necrosis, as reported in 5–28 % of cases and the mortality rate is reported in 50 % of cases [7]. Nonsurgical solutions for chronic GV could be considered, including antisecretory therapy, diet modifications (thickening of meals), and posture changes (ensuring patients are upright for feeds and consideration for positional changes with right side down or prone after feeding) [12]. No data are present about the outcome and follow-up of this condition.