Avoiding Diagnostic Delays in Neonatal Gastric Volvulus: A Rare Case With a Favorable Outcome

Neonatal gastric volvulus (GV) is a rare but potentially life-threatening condition caused by abnormal rotation of the stomach, leading to obstruction, ischemia, or perforation. Early diagnosis is challenging due to nonspecific initial symptoms and the limited diagnostic value of plain radiographs. We present a case of late preterm GV in which the diagnosis was delayed until repeat contrast imaging was performed. Timely surgical referral following this led to a favorable outcome. A male infant was delivered vaginally at 36 + 3 weeks' gestation, weighing 2200 g and measuring 44 cm, with Apgar scores of 7 and 8 at one and five minutes, respectively. Shortly after birth, he developed respiratory distress requiring mechanical ventilation in the NICU. Nasogastric tube placement revealed active gastric bleeding, prompting cryoplasma transfusion and initiation of parenteral nutrition. Reverse peristalsis, undigested gastric contents, and progressive abdominal distension followed attempts at minimal enteral feeding. Initial supine abdominal radiographs showed nonspecific gas distribution. On day 6, an upper gastrointestinal (GI) contrast study excluded intestinal obstruction but demonstrated delayed gastric emptying. Persistent symptoms led to a repeat contrast study, which revealed a spherical stomach with an air-fluid level, findings consistent with GV, prompting urgent surgical referral. This case underscores the diagnostic limitations of plain radiography in neonatal GV and the risk of delayed recognition when contrast imaging is postponed. Persistent GI symptoms, particularly feeding intolerance and unexplained distension, should prompt early escalation to targeted imaging modalities. In this case, initial radiographs failed to identify GV, delaying diagnosis. The abnormal rotation and positioning of the stomach became evident only on a later upper GI contrast study, allowing for timely diagnosis and surgical intervention. This case highlights the importance of early contrast imaging in neonates with persistent, unexplained GI symptoms to prevent avoidable delays in care.