Gastric Volvulus In Infants And Children

Gastric Volvulus in Infants and Children Randolph Kyle Cribbs, Kenneth William Gow and Mark Lewis Wulkan Pediatrics 2008;122;e752-e762; originally published online Aug 4, 2008; DOI: 10.1542/peds.2007-3111

The online version of this article, along with updated information and services, is located on the World Wide Web at: http://www.pediatrics.org/cgi/content/full/122/3/e752

PEDIATRICS isthe official journal of the American Academy of Pediatrics. A monthly publication, it has been published continuously since 1948. PEDIATRICS is owned, published, and trademarked by the American Academy of Pediatrics, 141 Northwest Point Boulevard, Elk Grove Village, Illinois, 60007. Copyright © 2008 by the American Academy of Pediatrics. All rights reserved. Print ISSN: 0031-4005. Online ISSN:1098-4275.

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REVIEW ARTICLE

Gastric Volvulus in Infants and Children
Randolph Kyle Cribbs, MDa, Kenneth William Gow, MDb, Mark Lewis Wulkan, MDa
a

Division of Pediatric Surgery, Emory University, Atlanta, Georgia; bDivision of Pediatric General and Thoracic Surgery, University of Washington, Seattle, Washington

The authors haveindicated they have no financial relationships relevant to this article to disclose.

ABSTRACT
INTRODUCTION. Gastric volvulus is an important cause of nonbilious emesis that must be

recognized early to ensure a good outcome. We reviewed 7 cases from our institution, Children’s Healthcare of Atlanta (Egleston campus). In addition, we reviewed all gastric volvulus cases in children published todate in the English literature to draw general conclusions about the presentation and treatment of this unusual disease.
METHODS. An electronic literature search was performed to find all published cases of pediatric gastric volvulus. The care of all children from January 2002 to December 2007 who were treated for gastric volvulus was also reviewed. RESULTS. There have been 581 cases of gastricvolvulus in children published in English

www.pediatrics.org/cgi/doi/10.1542/ peds.2007-3111 doi:10.1542/peds.2007-3111
Key Words adolescents, children, gastric, volvulus, infants, newborns Abbreviations PEH—paraesophageal hernia UGI— upper gastrointestinal HH— hiatal hernia CDH— congenital diaphragmatic hernia GERD— gastroesophageal reflux disease
Accepted for publication Mar 27, 2008 Addresscorrespondence to Mark Wulkan, MD, Emory University, Division of Pediatric Surgery, 2015 Uppergate Dr NE, Atlanta, GA 30322. E-mail: mark.wulkan@oz.ped.emory.edu PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online, 1098-4275). Copyright © 2008 by the American Academy of Pediatrics

between 1929 and 2007. Of these, 252 were acute and 329 were chronic cases. The most common presentation of acutegastric volvulus is in a child 5 years old with nonbilious emesis, epigastric distention, and abdominal pain. Acute gastric volvulus is often associated with deformities of adjacent organs. Definitive diagnosis is made with upper gastrointestinal studies, and definitive therapy requires repair of associated defects and anterior fixation of the stomach to the abdominal wall. The most common presentationof chronic volvulus is in an infant 1 year old with emesis, epigastric distention, feeding difficulties, and growth failure. Treatment may be medical or surgical depending on the underlying etiology of the volvulus.

CONCLUSIONS. Acute gastric volvulus is a potentially life-threatening occurrence with a good outcome when treated in a timely fashion. Chronic volvulus may be more difficult torecognize. The common features of acute and chronic gastric volvulus described in this review should assist pediatric health care providers in promptly diagnosing and treating this disease. Pediatrics 2008;122:e752–e762

ASTRIC VOLVULUS HAS traditionally been considered an uncommon cause of foregut obstruction and is usually described as having a peak incidence during the fifth decade of life.1–3 In...