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.