Management dilemma in a paediatric patient with chronic gastric volvulus: a case report

Abstract

Gastric volvulus in children is rare. While the acute form is a surgical emergency, the chronic form may be managed either surgically or conservatively. The present report describes a premature (26+1 weeks) Afro-Caribbean neonate girl who presented with severe multiple bradycardias and apnoeas; she subsequently underwent pH monitoring and a barium study which demonstrated gastro-oesophageal reflux disease (GORD) and gastric volvulus. The patient represented a management dilemma as there were delays in establishing the diagnosis since medical treatment was started before pH monitoring was performed, and because of complications of prematurity precluding surgical treatment. This case supports an association between GORD and gastric volvulus while arguing that the mode of treatment should be based upon the severity of symptoms. This case is of particular interest to paediatricians who might consider this diagnosis in infants presenting with non-specific gastrointestinal and feeding problems particularly in association with GORD.

A Case of Apparent Life-Threatening Event: Comorbid Gastric Volvulus Associated Gastroesophageal Reflux Disease and Epilepsy in a 4-Month-Old Boy

“…In the present case, we also detected an organoaxial GV via upper GI contrast study. GV, occasionally called gastric malrotation, is a condition where all or part of the stomach rotates around either a longitudinal (organoaxial) or a vertical (mesenteroaxial) axis by at least 180° to cause total or partial obstruction of stomach on acute, intermittent, or chronic basis [ 8 ]. The symptom of GV varies depending on the extent of gastric rotation and obstruction.…”

“…We assumed that preventing aerophagia by lifestyle modification with frequent belching and upright positioning might contribute to symptom amelioration, because intestinal distention induced by aerophagia aggravates volvulus by pushing the greater curvature of the stomach upwards [ 10 ]. Not a few authors advocate that GV is associated with GERD [ 8 – 14 ]. A patient described in Al-Salem's report presented apneic spells, and GV with severe GER was detected through barium contrast study.…”