| Acute and chronic gastric volvulus in infants and children: who should be treated surgically? | |
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MedLine Citation:
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PMID: 17874114 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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Gastric volvulus was first described by Berti in 1966. Whereas acute gastric volvulus is very rare, chronic gastric volvulus on the other hand is being diagnosed with increasing frequency. This is attributed to the liberal use of barium meal for the evaluation of infants and children with repeated attacks of vomiting and recurrent chest infection. This report describes our experience in the management of 36 infants and children with acute and chronic gastric volvulus. Their medical records were retrospectively reviewed for: age at diagnosis, sex, symptomatology, diagnosis, treatment and outcome. There were 22 males and 14 females. Their ages at presentation ranged from 1 week to 2.5 years (mean 6.7 months). Their symptomatology included repeated attacks of vomiting (30 patients), recurrent chest infection and asthma like symptoms (6 patients), failure to thrive (6 patients), chocking with feeds (3 patients), loose bowel motion (3 patients) and apnoea attack (1 patient). Two presented acutely with intrathoracic gastric volvulus. One of them had recurrent left diaphragmatic hernia while the other had a large paraesophageal hernia. The remaining patients had chronic intraabdominal gastric volvulus. Radiologically, all had organo-axial gastric volvulus except one who had mesenterico-axial gastric volvulus and 33 (97%) of them had demonstrable gastroesophageal reflux. Eleven were treated conservatively because their symptoms were mild to moderate and settled. The two patients with intrathoracic gastric volvulus underwent reduction of the contents, repair of the defect and anterior gastropexy. The remaining patients underwent gastropexy, both fundal and anterior. Intraoperatively, two were found to have diaphragmatic hernia, nine had mobile (non-fixed) spleen, and eight showed mobile stomach with lax ligaments. Post-operatively, all did well and showed good improvement with disappearance of their symptoms and increase in weight. Acute gastric volvulus is very rare. Prompt clinical suspicion and radiological assessment are essential to treat this life-threatening condition. Chronic gastric volvulus on the other hand is more common but under diagnosed. It should be included in the differential diagnosis of infants and children with repeated attacks of chest infection, vomiting and failure to thrive. Barium meal should form part of their investigations. The treatment of chronic gastric volvulus depends on their symptomatology. Those with mild to moderate symptoms should be treated conservatively, while those with persistent and severe symptoms should undergo anterior (to the abdominal wall) and fundal (to the diaphragm) gastropexy without fundoplication. |
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Authors:
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Ahmed H Al-Salem |
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Publication Detail:
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Type: Comparative Study; Journal Article Date: 2007-09-14 |
Journal Detail:
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Title: Pediatric surgery international Volume: 23 ISSN: 0179-0358 ISO Abbreviation: Pediatr. Surg. Int. Publication Date: 2007 Nov |
Date Detail:
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Created Date: 2007-10-16 Completed Date: 2008-03-06 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 8609169 Medline TA: Pediatr Surg Int Country: Germany |
Other Details:
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Languages: eng Pagination: 1095-9 Citation Subset: IM |
Affiliation:
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Department of Pediatric Surgery, Maternity and Children Hospital, Dammam, Saudi Arabia. ahalsalem@hotmail.com |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Acute Disease Child, Preschool Chronic Disease Decision Making* Digestive System Surgical Procedures / methods* Female Follow-Up Studies Humans Infant Infant, Newborn Male Prognosis Radiography, Abdominal Radiography, Thoracic Retrospective Studies Stomach Volvulus / radiography, surgery* |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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