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The pediatric diaphragm in acute gastric volvulus
R C McIntyre1, D D Bensard, F M Karrer
1Department of Pediatric Surgery, Children's Hospital, Denver, Colorado.
Journal of the American College of Surgeons
|March 1, 1994
Summary
Acute gastric volvulus in infants is linked to left diaphragmatic anomalies. Prompt surgical intervention, including diaphragmatic anomaly repair and gastric fixation, is crucial for positive outcomes in these pediatric cases.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Diaphragmatic Abnormalities
Background:
- Acute gastric volvulus is a rare but serious condition in infants.
- It is often associated with congenital anomalies, particularly those affecting the diaphragm.
- Early diagnosis and management are critical for patient survival.
Purpose of the Study:
- To review the clinical presentation, management, and outcomes of acute gastric volvulus in infants and children.
- To highlight the association between gastric volvulus and left-sided diaphragmatic anomalies.
- To emphasize the importance of prompt surgical intervention.
Main Methods:
- Retrospective review of ten patients (nine infants, one older child) with acute gastric volvulus over 19 years.
- Analysis of associated diaphragmatic anomalies (eventration, hiatal hernia, Bochdalek hernia).
- Review of clinical presentation, surgical procedures (diaphragmatic repair, gastric fixation), and patient outcomes.
Main Results:
- All ten patients had an associated left diaphragmatic anomaly.
- Vomiting was the most common presentation (9/10 patients).
- Eight patients had mesenteroaxial volvulus; two had organoaxial.
- Nine patients treated operatively survived with no recurrence; one patient died preoperatively due to gastric necrosis.
Conclusions:
- Acute gastric volvulus in infants should be suspected in cases of unexplained vomiting with left diaphragmatic anomalies.
- Immediate surgical intervention is mandatory for diagnosed cases.
- Surgical repair of the diaphragmatic anomaly combined with gastric fixation offers excellent outcomes.