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Intrathoracic gastric volvulus mimicking pyloric stenosis
J J Munoz1, A J Mansul, T J Malpas
1Department of Paediatrics, The General Hospital, Jersey, United Kingdom.
Insights
A congenital diaphragmatic hernia in an infant, initially suspected as pyloric stenosis due to vomiting, was unexpectedly diagnosed. This rare condition required urgent surgery for intrathoracic gastric volvulus.
Area of Science:
- Pediatric Surgery
- Neonatal Medicine
- Diagnostic Imaging
Background:
- Pyloric stenosis is a common cause of non-bilious vomiting in infants.
- Congenital diaphragmatic hernia (CDH) is a rare condition presenting with respiratory distress.
- Intrathoracic gastric volvulus is a life-threatening emergency.
Observation:
- A 5-week-old infant presented with non-bilious vomiting and metabolic alkalosis, mimicking pyloric stenosis.
- A chest radiograph, performed for an unrelated infection, incidentally revealed a left-sided congenital diaphragmatic hernia.
- A subsequent barium study confirmed an intrathoracic gastric volvulus.
Findings:
- The infant's vomiting was caused by a congenital diaphragmatic hernia with gastric volvulus, not pyloric stenosis.
- Congenital diaphragmatic hernia can present atypically with gastrointestinal symptoms.
- Prompt surgical intervention is crucial for managing intrathoracic gastric volvulus.
Implications:
- This case highlights the importance of considering rare diagnoses in infants with vomiting.
- Diagnostic imaging plays a critical role in identifying unexpected congenital anomalies.
- Early recognition and surgical management of CDH with gastric volvulus improve patient outcomes.
Abstract:
A 5-week-old-infant presented to hospital following the acute onset of non-bilious vomiting with clinical and acid-base features suggestive of pyloric stenosis. A chest radiograph obtained because of intercurrent infection unexpectedly revealed a left-sided congenital diaphragmatic hernia. A barium meal demonstrated the presence of an intrathoracic gastric volvulus, requiring urgent surgical management. We discuss the presentation and management of this rare surgical cause of non-bilious vomiting in infancy.