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Gastric volvulus, organoaxial or mesenteroaxial, Is an un- aspiration. Abdominal radiographs were interpreted as normal.
common cause of upper gastrointestinal obstruction in child- Over the next 2 weeks the vomiting persisted and was associ-
hood. It may be suspected on plain radiographic examination ated with increasing dyspnea and cyanosis. Exploration of the
of the abdomen and confirmed by upper gastrointestinal abdomen was planned but was postponed because of the
series. Seven affected chIldren are described. In childhood, pulmonary disease and death occurred 16 days after admission.
gastrIc volvulus often coexists with mesenteric abnormalities Review of the abdominal radiographs after the patients death
or with lesions that lead to distention of the gastrointestinal revealed findings consistent with intermittent organoaxial vol-
tract. vulus of the stomach (fig. 1). This had not been recognized
before death; rather, it was the pulmonary disease, the result of
Most of the literature concerning gastric volvulus has vomiting and aspiration, that drew most attention.
Case 2
B. C. a 5-month-old
, girl, was admitted for the second time
because of intermittent vomiting, poor growth, and chronic
cough. At her first admission at age 4 months for similar
symptoms, an upper gastrointestinal series demonstrated mal-
rotation of the bowel. At surgery, duodenal bands were lysed,
the small bowel was placed in the right hemiabdomen, and the
colon was placed in the left hemiabdomen (Ladds procedure).
However, hen symptoms were not relieved.
At readmission, physical examination revealed a pale, thin
Fig. 1.-Case 2. Upright film from upper gastrointestinal series.
infant; no abnormalities of the chest or abdomen were noted.
Transverse position of stomach, inferior location of esophagogastnic
Radiographic examination of the chest was abnormal and the junction (arrow), and distorted duodenum-typical features of organoax-
parenchymal alterations were felt to be consistent with chronic ial volvulus.
A
organoaxial volvulus. Itispresumed that aerophagia resulted in admission to our hospital, an intensive investigation was under-
chronic distention of the stomach which predisposed this pa- taken to explain his signs and symptoms. There was evidence
tient to volvulus. of a neunologic disorder as manifest by opisthotonic posturing,
clenching of the fists, and decreased sensory response. Aero-
Case 5
phagia was thought responsible for chronic distention of his
A. P., a 5-month-old boy, had been hospitalized several times gastrointestinal tract. Partial organoaxial volvulus of the stom-
because of vomiting, dehydration, and failure to thrive. On ach, hiatus hernia, gastrointestinal reflux, and aspiration were
AJR:132, June 1979 GASTRIC VOLVULUS IN CHILDHOOD 923
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Fig. 4.-Case 7.Supine (A) and upright (B) plain abdominal radio-
graphs. Spherical mass in midabdomen with typical beak of mesenter-
oaxial volvulus (arrow), confirmed by upper gastrointestinal series (C).
demonstrated by an upper gastrointestinal series. At surgical the abdomen and an upper gastrointestinal series showed a
exploration of the abdomen, the partial volvulus was reduced; mesenteroaxial gastric volvulus (fig 3). Surgical exploration
fundoplication and gastrostomy were performed. revealed the volvulus and abnormal mesenteric attachment.
Lysis of bands , gastropexy , and a gastrostomy were performed.
Case 6
Case 7
S. F. a 4/-year-oId
, girl, had been admitted many times for
evaluation and treatment of spastic quadraplegia and mental M. I., a 3-year-old boy, experienced recurrent vomiting for 1
retardation The most recent admission
. was related to recurrent year. History included several admissions for management of
nonbilious vomiting. The child was known to be aerophagic. bilateral hydronephrosis and hydroureter. The etiology of the
Physical examination of the abdomen was difficult, but did vomiting was never clear. During a routine hospital visit for
reveal it to be protuberant and tympanitic and a moveable evaluation of his urinary tract, a review of the radiographic
epigastric mass was palpated. The radiographic examination of examinations of the abdomen revealed, on some, evidence of a
924 ZIPRKOWSKI AND TEELE AJR:132, June 1979
courage volvulus of the stomach on its long axis in these 4. Kilcoyne RF, Babbitt DP, Sakaguchi 5: Volvulus of the
patients [12]. stomach. Radiology 1 03 : 1 57-1 58, 1972
The diagnosis of gastric volvulus should be considered 5. Dalgaard JR : Volvulus of the stomach . Acta Chir Scand 103:
in any child who has acute abdominal pain, retching, 131-153, 1952
6. DeLorimier AA, Penn L: Acute volvulus of the stomach
and gastric distention. Plain films taken before de-
emphasizing management hazards. AJR 77 : 627-633, 1957
compression of the stomach with nasogastric tube often
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