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Idiopathic gastric volvulus in infancy and childhood
Insights
Idiopathic gastric volvulus, common in infants, presents with vomiting and distention. Conservative treatment with upright positioning is often effective, but surgery may be needed for older children.
Area of Science:
- Pediatric Surgery
- Gastroenterology
Background:
- Idiopathic gastric volvulus is a recognized condition, particularly prevalent in neonates and infants.
- The study reviews 44 cases managed between 1966 and 1980, with 22 patients under one year of age.
Purpose of the Study:
- To analyze the clinical presentation, diagnostic methods, and treatment outcomes of idiopathic gastric volvulus in pediatric patients.
- To evaluate the efficacy of conservative and surgical management strategies.
Main Methods:
- Retrospective review of 44 pediatric gastric volvulus cases.
- Analysis of symptoms based on age groups (under 1 year vs. over 2 years).
- Diagnostic reliance on upper gastrointestinal series; treatment approaches included conservative positioning and surgical fixation.
Main Results:
- Vomiting and abdominal distention were primary symptoms in infants; older children presented with distention, weight loss, nausea, and appetite loss.
- Upper G.I. series proved crucial for diagnosis.
- One acute case required emergency surgery; chronic volvulus was managed conservatively with upright positioning post-feeding, except for two cases.
- Seventy-seven percent of patients over two years old necessitated surgical intervention.
- Gastric fornix fixation to the diaphragm yielded satisfactory results.
Conclusions:
- Conservative management, including upright positioning after feeding, is effective for chronic gastric volvulus in many pediatric cases.
- Surgical fixation of the gastric fornix to the diaphragm is a recommended and successful procedure for cases requiring intervention, especially in older children.
Abstract:
Idiopathic gastric volvulus is not rare, especially in the neonate and in infancy. Between 1966 and 1980 we managed 44 cases of gastric volvulus. In 22 of the cases, initial examination was performed under 1 year of age. The main symptoms in this group were vomiting and abdominal distention, while those in the group over 2 years of age were abdominal distention, weight loss, nausea, appetite loss etc. The upper G.I. series were the most important in diagnosis. There was only one case of acute volvulus, which was treated operatively on an emergency basis. Chronic volvulus could be treated conservatively, except in 2 cases. This consisted in the positioning of the patient in the upright right recumbent position after feeding, for at least 1 hour. In the supine position, the gastric fundus is filled and dilated when the milk is poured into the stomach, the fundus is pulled postero-caudally and the antrum is pulled upwards, resulting in the combined type of organo-axial and mesenterico-axial volvulus. Over 2 years of age, 77% required operation. The fixation of the gastric fornix with the diaphragm was performed, using 5 or 6 stitches. The result was quite satisfactory. We recommend this procedure in this operation.