Pediatric Gastric Volvulus

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Pediatric Gastric Volvulus

  1. 1. Pediatric Gastric Volvulus Rebecca Starr, D.O. PICU Review 4/8/14
  2. 2. 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
  3. 3. Anatomy Review
  4. 4. Volvulus Etiology • Ligament abnormalities • Abnormalities of gastric anatomy or gastric function • Abnormalities of adjacent organs • Diaphragm • Spleen • Transverse colon • Intestines • Liver
  5. 5. Organoaxial Gastric Volvulus
  6. 6. Mesenteroaxial Gastric Volvulus
  7. 7. Combined Gastric Volvulus
  8. 8. Most Common Pediatric Presentation • Child <5 years old • Nonbilious emesis • Epigastric distention • Abdominal pain
  9. 9. Acute vs Chronic
  10. 10. 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
  11. 11. Mortality Rates • Acute volvulus- 7% • Chronic volvulus- 3% • Nonsurgical chronic volvulus management- 0.8%
  12. 12. References • Cribbs RK, Gow KW, and Wulkan ML. Gastric volvulus in infants and children. Pediatrics. 2008; 122:752-762.

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