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Gastric volvulus in the pediatric population
D L Miller1, M D Pasquale, R P Seneca
1Department of General Surgery, Georgetown University Hospital, Washington, DC 20007.
Insights
Acute gastric volvulus is rare in children, often linked to anatomical issues. Prompt diagnosis and surgical intervention are crucial for survival, as delays can lead to severe complications and death.
Area of Science:
- Pediatric Surgery
- Gastrointestinal Surgery
- Emergency Medicine
Background:
- Acute gastric volvulus is a rare but life-threatening condition in pediatric patients.
- Mesenteroaxial volvulus is the predominant type in children, frequently associated with anatomical abnormalities.
Observation:
- Delayed diagnosis of acute gastric volvulus in children significantly increases the risk of gastric ischemia, perforation, and mortality.
- Nonoperative management carries an 80% mortality rate, highlighting the urgency of timely intervention.
Findings:
- Early recognition and surgical intervention, including gastric reduction, fixation, and repair of associated defects, are essential for managing pediatric acute gastric volvulus.
- The rarity of the condition (77 documented cases since 1899) underscores the need for heightened clinical awareness.
Implications:
- Prompt surgical management improves outcomes for children with acute gastric volvulus.
- Understanding the association with anatomical defects is key for successful surgical repair and preventing recurrence.
- Increased awareness and diagnostic accuracy in pediatric emergency settings can reduce mortality associated with this condition.
Abstract:
Acute gastric volvulus in children is uncommon. Since 1899, only 77 cases have been documented in the world literature. In children, mesenteroaxial volvulus is the most common type and associated anatomic defects are the rule. Diagnostic delays result in gastric ischemia, perforation, and death. Nonoperative mortality is 80%. Early recognition, surgical reduction with gastric fixation, and repair of associated defects are the mainstays of therapy for acute gastric volvulus in the pediatric population.