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.

Diagnosis of pediatric gastric, small-bowel and colonic volvulus.

Digestive volvulus affects the stomach, small bowel and mobile segments of the colon and often has a developmental cause. Reference radiologic examinations include upper gastrointestinal contrast series for gastric volvulus, possibly with ultrasonography for small-bowel volvulus, and contrast enema for colonic volvulus. Treatment is usually surgical. This pictorial essay describes the embryological development and discusses the clinical and radiologic presentation of volvulus, depending on location, and details the appropriate radiologic examinations.

[Volvulus in childhood]. / Der Volvulus im Kindesalter.

Gastric volvulus or volvulus of the small-bowel can occasionally be found in neonates and small infants. Since volvulus is an emergency case, the radiologist must know the characteristic radiological findings and the ultrasound signs in correlation to the clinical symptoms. Two forms of gastric volvulus can be distinguished: the organoaxial type and a mesenterioaxial form. Besides an idiopathic etiology, diaphragmatic alterations can be observed in children with volvulus of the stomach. Volvulus of the small-bowel occurs in children with malrotation type I or II or with nonrotation. Bile-stained vomiting starts within the first days of life and is followed by the clinical signs of high bowel obstruction and peritonitis. Primarily in cases of gastric volvulus, an ultrasound examination can show the wrong position of the stomach or the pyloric region. In cases of small-bowel volvulus, abnormal localization of the superior mesenteric artery can be demonstrated. The plain film features an upper small-bowel obstruction. Upper intestinal contrast studies may reveal the level of small-intestine obstruction. A contrast enema can rule out a concomitant colon nonrotation or malrotation. A rare form which can be misdiagnosed easily, is volvulus of the sigmoid with pathological elongation and positioning of the sigma. It appears mostly in school children with less urgent symptoms and can disappear spontaneously. A typical feature is pain in the left lower abdomen and complete obstruction in an opaque enema.