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Acute gastric volvulus: Late-onset ischemic consequences and their management
Kshama Vasudev Kulkarni1, Sudipta Sen, Sampath Karl
1Department of Paediatric Surgery, Christian Medical College, Vellore, Tamilnadu, India.
Journal of Indian Association of Pediatric Surgeons
|November 29, 2011
Summary
Acute gastric volvulus in infants can lead to severe complications like microgastria and strictures. Surgical reconstruction offers better outcomes for these complex cases.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Neonatal Care
Background:
- Acute gastric volvulus is a rare but serious condition in infants.
- Initial detorsion may not prevent long-term sequelae from ischemia.
- Complications include microgastria and strictures of the gastroesophageal and gastroduodenal junctions.
Observation:
- Three infants presented with acute gastric volvulus.
- Two infants developed severe feeding issues due to microgastria and strictures.
- One infant, treated non-surgically, succumbed to sepsis and malnutrition.
Findings:
- Nonsurgical management with dilatations failed in one case, leading to death.
- One infant required ileocecal segment reconstruction after esophageal perforation during attempted dilatation.
- Another infant underwent successful gastric substitution with a Hunt Lawrence J pouch.
Implications:
- Delayed gastric ischemia following volvulus can cause significant morbidity.
- Surgical reconstruction, such as ileocecal or Hunt Lawrence J pouch, is crucial for long-term feeding success.
- Early recognition and aggressive management are vital for improving outcomes in infant gastric volvulus.
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