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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.

BMJ Case Reports
|September 16, 2011
PubMed

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.

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