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Pediatric Gastric VolvulusRebecca Starr, D.O.
PICU Review
4/8/14
What is Gastric Volvulus?
• Twisting of all or a portion of the stomach at least 180° about an axis that causes an obstruction of the foregut
• Rare in children
• Acute, intermittent, recurrent, or chronic
• Acute gastric volvulus• Life- threatening occurrence
• Good outcome when treated quickly
• Chronic volvulus may be more difficult to recognize
Anatomy Review
Volvulus Etiology
• Ligament abnormalities
• Abnormalities of gastric anatomy or gastric function
• Abnormalities of adjacent organs • Diaphragm
• Spleen
• Transverse colon
• Intestines
• Liver
Organoaxial Gastric Volvulus
Mesenteroaxial Gastric Volvulus
Combined Gastric Volvulus
Most Common Pediatric Presentation
• Child <5 years old
• Nonbilious emesis
• Epigastric distention
• Abdominal pain
Acute vs Chronic
Diagnosis and Treatment
• Definitive diagnosis- upper GI
• Definitive therapy- repair of associated defects and anterior fixation of the stomach to the abdominal wall
• Surgical repair- mortality rate 5%• Simple reduction
• Open or laparoscopic gastropexies
• Gastrostomy-tube placements
• Fundoplications
Mortality Rates
• Acute volvulus- 7%
• Chronic volvulus- 3%
• Nonsurgical chronic volvulus management- 0.8%
References
• Cribbs RK, Gow KW, and Wulkan ML. Gastric volvulus in infants and children. Pediatrics. 2008; 122:752-762.
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