Gastric volvulus is a twisting of the stomach by at least 180 degrees that causes an obstruction. It is rare in children but can be life-threatening if acute. Chronic volvulus may be more difficult to recognize. Causes include ligament abnormalities or issues with adjacent organs like the diaphragm or transverse colon. The most common pediatric presentation is in a child under 5 with non-bilious vomiting, epigastric distention, and abdominal pain. Diagnosis is made via upper GI imaging and treatment involves surgical repair of defects and fixing the stomach to the abdominal wall, with a mortality rate of around 5% for surgery.

1. Pediatric Gastric
Volvulus
Rebecca Starr, D.O.
PICU Review
4/8/14

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. Anatomy Review

4. Volvulus Etiology
• Ligament abnormalities
• Abnormalities of gastric anatomy or gastric function
• Abnormalities of adjacent organs
• Diaphragm
• Spleen
• Transverse colon
• Intestines
• Liver

5. Organoaxial Gastric Volvulus

6. Mesenteroaxial Gastric Volvulus

7. Combined Gastric Volvulus

8. Most Common Pediatric Presentation
• Child <5 years old
• Nonbilious emesis
• Epigastric distention
• Abdominal pain

9. Acute vs Chronic

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. Mortality Rates
• Acute volvulus- 7%
• Chronic volvulus- 3%
• Nonsurgical chronic volvulus management- 0.8%

12. References
• Cribbs RK, Gow KW, and Wulkan ML. Gastric volvulus in infants and
children. Pediatrics. 2008; 122:752-762.