Gastric organo-axial malrotation coexisting respiratory symptoms

Gastric malrotation is defined as a torsion of stomach around its short or long axis. It is a rare disease in childhood. Gastric malrotation may present either as a surgical emergency or as chronic abdominal symptoms. There is limited data about the respiratory symptoms associated with gastric malrotation. The aim of this study was to review the records of 14 children who presented with respiratory symptoms and diagnosed as gastric organo-axial malrotation. Between August 2005 and August 2007, 14 children diagnosed as having gastric organo-axial malrotation participated in this study. There were 11 boys and three girls with a mean age of 7.1 months. All patients were symptomatic. Presenting symptoms included wheezing in four patients, recurrent pneumonia in four, chronic cough in two, chronic cough and apnea in two, recurrent pneumonia and chronic cough in one, and chronic cough and failure to thrive in one. All of our patients had organo-axial gastric malrotation. Gastroesophageal reflux was found in nine patients (64.2%). Six patients were treated with surgery and antireflux medication and the remaining eight patients with antireflux medication. In conclusion, it is probable that gastric malrotation associated with massive or occult gastroesophageal reflux could be responsible for the respiratory symptoms such as chronic cough, recurrent pneumonia, wheezing, and apnea.