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Management dilemma in a paediatric patient with chronic gastric volvulus: a case report
Karl D F M Norrington1, Peter Reynolds
1Imperial College London, Faculty of Medicine, Charing Cross Campus, St Dunstan's Road, London, W6 8RP, UK.
Insights
Gastric volvulus, a rare condition in infants, can be associated with gastro-oesophageal reflux disease (GORD). Treatment for gastric volvulus depends on symptom severity, especially in premature infants.
Area of Science:
- Pediatric Surgery
- Neonatology
- Gastroenterology
Background:
- Gastric volvulus is uncommon in pediatric patients.
- Acute gastric volvulus requires immediate surgical intervention, while chronic forms may be managed non-surgically or surgically.
- Premature infants with non-specific gastrointestinal issues may present with gastric volvulus and GORD.
Purpose of the Study:
- To report a case of gastric volvulus in a premature neonate.
- To highlight the diagnostic challenges and management considerations for gastric volvulus in infants.
- To explore the association between GORD and gastric volvulus in neonates.
Main Methods:
- Case report of a premature neonate (26+1 weeks).
- Diagnostic procedures included pH monitoring and barium study.
- Clinical presentation involved severe bradycardias and apnoeas.
Main Results:
- The neonate was diagnosed with both gastro-oesophageal reflux disease (GORD) and gastric volvulus.
- Diagnostic delays occurred due to initial medical management before pH monitoring.
- Complications of prematurity complicated surgical treatment options.
Conclusions:
- This case supports a link between GORD and gastric volvulus in infants.
- Treatment decisions for gastric volvulus should be guided by symptom severity.
- Pediatricians should consider gastric volvulus in infants with feeding difficulties and GORD.
Abstract:
Gastric volvulus in children is rare. While the acute form is a surgical emergency, the chronic form may be managed either surgically or conservatively. The present report describes a premature (26+1 weeks) Afro-Caribbean neonate girl who presented with severe multiple bradycardias and apnoeas; she subsequently underwent pH monitoring and a barium study which demonstrated gastro-oesophageal reflux disease (GORD) and gastric volvulus. The patient represented a management dilemma as there were delays in establishing the diagnosis since medical treatment was started before pH monitoring was performed, and because of complications of prematurity precluding surgical treatment. This case supports an association between GORD and gastric volvulus while arguing that the mode of treatment should be based upon the severity of symptoms. This case is of particular interest to paediatricians who might consider this diagnosis in infants presenting with non-specific gastrointestinal and feeding problems particularly in association with GORD.
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