Gastric volvulus in children: our experience

Abstract

Gastric volvulus is an extremely rare disorder in the pediatric age group. It is a complex entity as to the etiology and management. The study was conducted to evaluate etiology, mode of presentation, management, and outcome in our patients with gastric volvulus. It was a retrospective study of 10 patients with gastric volvulus managed during May 2006 and October 2010. The medical record of these patients including history, clinical examination, investigations, operative notes, and the outcome was reviewed. Of the ten patients, seven were males and three females. The mean age of presentation was 2.87 years. Half (50 %) of the patients showed typical Borchardt triad whereas in other patients the presentation was variable. In eight patients, the diagnosis was precisely made with the help of radiological investigations. At operation, three patients had primary gastric volvulus, and seven had secondary gastric volvulus. The predisposing factors leading to secondary gastric volvulus were eventration of diaphragm, hiatus hernia, congenital diaphragmatic hernia, malrotation, and traumatic diaphragmatic rupture. Seven patients had organoaxial volvulus and three showed mesenterioaxial. Gastropexy was performed in three patients (primary gastric volvulus). In seven patients (secondary gastric volvulus), the predisposing anatomical defects were corrected without adding gastropexy in the regime. One patient with traumatic rupture of the diaphragm died. There was no recurrence in any patient over a mean follow up of 3.7 years (SD ± 1.27). Secondary gastric volvulus is prevalent with diaphragmatic defects sharing major contribution in the etiology. Classical Borchardt triad is seen in 50 % cases of pediatric gastric volvulus. Correction of predisposing factors alone is sufficient to manage secondary gastric volvulus in children.