An acute gastric volvulus in a child with congenital left diaphragmatic hernia: a case report.

BACKGROUND: Acute complete gastric volvulus is a rare and life-threatening disease, which is prone to gastric wall ischemia, perforation, and necrosis. If it is not treated by surgery in time, the mortality rate can range from 30 to 50%. Clinical presentations of acute gastric volvulus are atypical and often mimic other abdominal conditions such as gastritis, gastroesophageal reflux, gastric dilation, and pancreatitis. Imaging studies are crucial for diagnosis, with barium meal fluoroscopy being the primary modality for diagnosing gastric volvulus. Cases of acute gastric volvulus diagnosed by ultrasound are rarely reported. CASE PRESENTATION: We reported a rare case of acute gastric volvulus in a 4-year-old Chinese girl who presented with vomiting and abdominal pain. Ultrasound examination revealed the "whirlpool sign" in the cardia region, raising suspicion of gastric volvulus. Diagnosis was confirmed by X-ray barium meal fluoroscopy, which indicated left-sided diaphragmatic hernia and obstruction at the cardia region. Surgical intervention confirmed our suspicion of acute complete gastric volvulus combined with diaphragmatic hernia. CONCLUSION: In this case, we reported an instance of acute complete gastric volvulus. Ultrasound revealed a "whirlpool sign" in the cardia, which is likely to be a key sign for the diagnosis of complete gastric volvulus.

The Evaluation of Gastric Emptying Using the 13 C-Acetate Breath Test in Neurologically Impaired Patients - A Focus on the Stomach Function and Morphology.

PURPOSE: We explored factors affecting gastric emptying in neurologically impaired (NI) patients using the 13C-acetate breath test. METHODS: Twenty-four NI patients were classified by the presence of gastroesophageal reflux disease (GERD), which was treated by fundoplication plus gastrostomy, or the absence of GERD, which was treated by gastrostomy alone, along with gastric malposition involving cascade stomach and organoaxial gastric volvulus (OGV). Gastric emptying parameters (GEPs), which were the emptying half time (T 1/2 , minute), the lag phase time (T lag , minute), and the gastric emptying coefficient (GEC), were measured before and after surgery. We evaluated the relationship between GEPs and GERD, gastric malposition, and surgical intervention. All data were expressed as the median (interquartile range). RESULTS: The T1/2 and GEC of patients with OGV were significantly worse than in those without OGV before surgery (T1/2 with OGV: 241.3 [154.9, 314.3] vs. T1/2 without OGV: 113.7 [105.2, 151.4], p = 0.01, GEC with OGV: 3.19 [2.46, 3.28] vs. GEC without OGV: 3.65 [3.24, 3.90], p = 0.02). GERD and cascade stomach were not associ ated with GEPs. The GEPs of all NI patients showed no significant difference between before and after surgery. The surgical change in T1/2 (ΔT 1/2 ) in the patients with OGV was significantly lower than in those without OGV (ΔT1/2 with OGV: -47.1 [-142.7, -22.1] vs. ΔT1/2 without OGV: -3.78 [-26.6, 12.0], p = 0.03). CONCLUSION: Stomach malposition, such as OGV, seems to affect gastric emptying and may be improved by surgi cal intervention.

Mesentero-axial gastric volvulus in an old woman: a case report of a diagnostic challenge.

Gastric volvulus is a rare conditiom defined as an abnormal rotation of the stomach around itself. Acute gastric volvulus is a surgical emergency because it is a life-threatening condition, but its non-specific symptoms make diagnosis difficult. There are two types of gastric volvulus: organoaxial and mesentero-axial. The treatmet is surgical intervention. Computed tomography allows to identify and classify gastric volvulus and rule out complications so that to guide surgery management. We report a case of a mesentero-axial gastric volvulus in an old woman with abdominal pain, who underwent surgery in laparoscopy.

Acute abdomen with gastric volvulus revealing an underlying pneumatosis cystoides intestinalis: a case report.

BACKGROUND: Pneumatosis intestinalis is an abnormal presence of free air outside the lumen of the intestines in many shapes. It is classified based on its etiology to primary or secondary, it affects adults as well as infants and can involve any part of the GI tract. CASE PRESENTATION: We report a case of a 55-year-old man with a past medical history of a surgically repaired perforated duodenal ulcer who presented with an acute abdominal pain, Flatulence and constipation. On examination of the abdomen; severe distension, tenderness and tympanicity on percussion were noted. An erect CXR was performed and showed bilateral sub-diaphragmatic air levels. We performed an abdominal Paracentesis under the right subcostal margin which led to evacuation of large amounts of air. Next, an investigational laparotomy showed that the reason was a gastric volvulus associated with an anterior and posterior gastric wall lacerations. The suitable surgical repair approach was taken, but another lesion was detected incidentally. A pneumatosis cystoides intestinalis (PCI) was extended along large length of the intestines in many shapes and without any symptoms or signs. CONCLUSIONS: Pneumatosis cystoides intestinalis has been reported continuously in relation to peptic ulcer disease (PUD). We aim to report a new association of a gastric volvulus and PCI secondary to pyloric stenosis caused by a duodenal ulcer; which we believe can aid in the diagnosing of dangerous complications, of a rare disease.

[Gastric dilatation-volvulus syndrome in guinea pigs (Cavia porcellus)]. / Magendrehung (Dilatatio et Torsio ventriculi) beim Meerschweinchen (Cavia porcellus).

AIM: The aim of this study was to present an overview of the gastric dilatation-volvulus syndrome in guinea pigs. MATERIAL AND METHODS: Four cases of gastric dilatation-volvulus syndrome in guinea pigs were evaluated. Its clinical presentation, diagnostic options, therapeutical approach and possible alternatives thereof were discussed. Furthermore, risk factors for the disease as well as pathophysiology and etiology were discussed and compared to the situation in other species. RESULTS: The presented cases indicate that in addition to anamnesis and clinical examination, radiography is the means of choice to diagnose a gastric dilatation-volvulus syndrome in guinea pigs. All four patients underwent surgery. One animal was euthanized during surgery, the other three guinea pigs died postoperatively. CONCLUSION AND CLINICAL RELEVANCE: Gastric dilatation-volvulus syndrome in guinea pigs is considered to be an emergency and, therefore, immediate stabilization is necessary, as well as surgery in almost all cases. The prognosis of this disease is guarded to poor.

Chronic gastric volvulus.

Gastric volvulus is an abnormal rotation of the stomach around his axis. The chronic presenting, as the acute one, is considered as a surgical emergency. We report 4 cases of chronic gastic volvulus. In 2 cases, it was a mesenterico-axial volvulus while in the 2 other cases it was an organo-axial volvulus. The barium enema made the diagnosis in all cases. The volvulus was secondary to a hernia in 3 cases and an agenesis of left diaphragmatic dome with ligament laxity in 1 case. All the patients underwent surgery. The laparoscopic approach was used in two patients.

[Endoscopic management of gastric volvulus in a 8-years old girl]. / Manejo endoscópico del vólvulo gástrico en una niña de 8 años.

INTRODUCTION: Gastric volvulus is a rare cause of acute abdomen in childhood, and it is usually a casual finding. We present the case of a girl with mesenteroaxial gastric volvulus, which was initially treated by endoscopic approach. CLINICAL CASE: 8 year-old patient, diagnosed of Down syndrome, who presented sudden and diffuse colic pain, associated with vomiting, sialorrhea and progressive compromise. She entered in bad general condition. At the physical examination it was highlighted a large abdominal mass. In the imaging study, a mesenteroaxial gastric volvulus and wandering spleen were confirmed. It was decided to perform an endoscopic gastric devolvulation under general anesthesia. Subsequently, gastropexy and splenopexy were performed by laparotomic approach. Evolution was uneventful, being discharged at the tenth postoperative day. COMMENTS: Endoscopic gastric devolvulation is an effective procedure in patients with gastric volvulus, especially in cases of great compromise of the general state, in which a prolonged surgery could suppose a greater risk.

INTRODUCCION: El vólvulo gástrico es una causa rara de abdomen agudo en la edad pediátrica, siendo generalmente un hallazgo. Se presenta el caso de una niña con vólvulo gástrico mesenteroaxial, que fue inicialmente tratado de forma endoscópica. CASO CLINICO: Paciente de 8 años, afecta de síndrome de Down, que acude por presentar un cuadro clínico de dolor abdominal cólico y súbito, asociado a vómitos, sialorrea y compromiso de estado general. La paciente ingresa en malas condiciones. Al examen físico, se constató una gran masa abdominal. Las exploraciones complementarias de imagen demuestran un vólvulo gástrico mesenteroaxial asociado a bazo errante. Se optó por efectuar desvolvulación gástrica endoscópica bajo anestesia general. Posteriormente a través de una laparotomía se realizó gastropexia y esplenopexia, evolucionando bien, siendo dada de alta al décimo día. COMENTARIOS: La desvolvulación endoscópica se presenta como una alternativa efectiva en pacientes afectos de vólvulo gástrico, en especial en casos de gran compromiso sistémico, en los que una cirugía prolongada pudiera suponer mayor riesgo.

Gastric volvulus through Morgagni hernia and intestinal diverticulosis in an adult patient: a case report.

BACKGROUND: Morgagni's hernia (MH) is a rare type of congenital diaphragmatic hernia with limited available literature. Late presentations are infrequent and the ones complicated due to gastric volvulus are even rarer. Another uncommon association of MH is with small bowel diverticulosis. We herein discussed a case of gastric volvulus as the content of MH, and small bowel diverticulosis present in a patient concomitantly. CASE PRESENTATION: A 30 year old woman, who presented with a one year history of epigastric burning and indigestion, occasionally associated with pain and vomiting. On clinical examination, no clue to the diagnosis could be ascertained. Her chest and abdominal x-ray indicated an abnormal air-fluid level at right hemithorax, which prompted a Computed Tomography (CT) scan, showing organo-axial gastric volvulus. MH with gastric volvulus was observed during laparotomy and trans-thoracic reduction of the contents was performed, along with repair of the defect. Multiple intestinal diverticuli were also found and the largest diverticulum was excised. CONCLUSIONS: Gastric volvulus through MH is a rare but potentially life-threatening condition. Non-specific symptoms like epigastric pain and vomiting can delay the diagnosis and management, however, advanced imaging techniques like CT scan can speed up this process. After the diagnosis is made, surgical repair should be attempted regardless of symptoms.

Feeding difficulty in an infant: an unusual cause.

A 10-month-old girl, with spondyloepiphyseal dysplasia congenita and posterior cleft palate had presented at 23 days of life with history of feeding difficulties. A diagnosis of oropharyngeal dysphagia and gastro-oesophageal reflux disease was made, for which she was started on nasogastric tube feeding and oral ranitidine. However, she continued to have poor development of oropharyngeal skills, persistent reflux as well as poor growth and was planned for gastrostomy at 10 months of age. She underwent soluble upper gastrointestinal contrast study prior to gastrostomy placement to rule out anatomical causes of vomiting, which showed the greater curvature of the stomach to be lying above the lesser curvature, suggesting a diagnosis of gastric volvulus, likely chronic, given that she did not have a history of abdominal distension, irritability or recurrent vomiting. On diagnosis of gastric volvulus, our patient underwent laparoscopic gastrostomy creation and is doing well postoperatively.

Role of Diagnostic Preoperative Upper Gastrointestinal Endoscopy in Radiologically Confirmed Gastric Volvulus.

BACKGROUND AND AIMS: Gastric volvulus (GV) is a life-threatening condition that warrants prompt diagnosis and treatment. GV is a radiologic diagnosis. The role of preoperative upper gastrointestinal endoscopy (UGIE) for individuals with radiologically confirmed GV is poorly defined. Our objective was to assess the diagnostic yield of UGIE in the preoperative evaluation of patients presenting with radiologically confirmed GV. METHODS: Retrospective review of all adult patients undergoing surgery for GV between July 1996 and August 2016 has been carried out. We performed analyses evaluating diagnostic yield of preoperative UGIE and compared outcomes in patients who did and did not undergo preoperative UGIE. Outcomes were diagnostic yield of preoperative UGIE, length of hospital stay, postoperative complications, and mortality at 30 days and 1 year. RESULTS: In the preoperative UGIE group, the diagnostic yield was 34.6% (27/78). The most common endoscopic findings were erosive esophagitis (13/27) and clean based gastric or duodenal ulcers (5/27). There were no cases of esophago-gastric malignancy. Three patients had ulcers with stigmata of recent bleeding, and three patients had features suggestive of gastric ischemia. Endoscopic findings did not influence surgical management. There was no statistically significant difference in mortality between patients who did and did not undergo preoperative UGIE, both at 30 days (0 vs. 2.5%) and 1 year (3.8 vs. 7.5%). CONCLUSION: Among patients with radiologically confirmed GV, preoperative UGIE rarely demonstrates clinically significant findings and can potentially delay definitive surgical intervention.

Spontaneous gastric dilatation-volvulus in two cats.

OBJECTIVES: To describe 2 cases of gastric dilatation-volvulus (GDV) in cats. To describe 2 unique clinical settings in which the disease occurs in cats, and to highlight the differences between GDV in cats and dogs. CASE SERIES SUMMARY: Two neutered female Persian cats were presented for evaluation of respiratory distress. Initial physical examination revealed tachypnea, dyspnea, and a markedly distended and painful abdomen in both cats. Radiographs revealed a gas-dilated stomach and gastrointestinal (GI) tract in both cats but were only diagnostic for GDV in 1 case. Gastric dilatation-volvulus was confirmed during exploratory laparotomy and gastropexy was performed in each case. Both cats were successfully discharged from the hospital. NEW AND UNIQUE INFORMATION PROVIDED: Gastric dilatation-volvulus in cats is a rare event and appears to occur in 2 clinical settings: in combination with traumatic diaphragmatic hernia (as previously reported) and without a history of trauma or diaphragmatic hernia, as in the 2 cases reported here. Clinicians should consider GDV in the list of differentials for cats with respiratory distress and abdominal distension, even if classic radiographic findings are not present.

A rare cause of severe epigastric pain, emesis and increased lipase.

INTRODUCTION: Gastric volvulus is an uncommon, but severe pathology requiring early diagnosis and urgent treatment. Its atypical symptoms and rarity make it difficult to diagnose, possibly leading to delayed treatment and fatal complications. PATIENTS AND METHODS: We present a case of a 73-year-old patient with Parkinson's disease with complaints of severe epigastric pain, emesis and an increased lipase. RESULTS: Diagnosis of an organo-axial gastric volvulus was made. Treatment consisted of reduction of the volvulus by decompression via nasogastric tube. The underlying cause was a para-esophageal hernia that was repaired by Nissen-fundoplication later on. CONCLUSIONS: We describe symptomatology, diagnostic and therapeutic options of gastric volvulus.