ABSTRACT
Gastric volvulus is a rare, potentially life-threatening condition first described by Berti in 1866.1 A review of the world literature in 1980 identified only 51 cases in children under 12 years of age.2 Of these, 26 (52%) were infants and half of these were younger than 1 month of age. In recent series, neonates have accounted for an even greater proportion of cases.3,4 In older children, gastric volvulus may be associated with neurodevelopmental handicap but in neonates there is a strong link with diaphragmatic defects. In the last 2 decades, numerous descriptions of acute and chronic gastric volvulus in children have been published, bringing the total number of reported cases to more than 100.3-8
Gastric volvulus may be defined as an abnormal rotation of one part of the stomach around another;9 the degree of twist varies from 180o to 360o and is associated with closed loop obstruction and the risk of strangulation. Lesser degrees of gastric torsion are probably common, frequently asymptomatic, and are not diagnostic of volvulus. Such cases may be associated with transient vomiting in infants but spontaneous resolution is the rule.7,10 Gastric volvulus may be either organoaxial, occurring around an axis joining the esophageal hiatus and the pyloroduodenal junction, or mesenteroaxial, around an axis joining the midpoint of the greater and lesser curves of the stomach (Fig. 41.1). Both types of volvulus occur with similar frequency.4 A mixed picture occurs if the stomach rotates around both axes simultaneously. The usual direction of rotation is anterior, i.e. in organoaxial volvulus the greater curve moves upwards and forwards above the lesser curve, causing the posterior gastric wall to face anteriorly. The gastroesophageal junction and the pylorus may both become obstructed. In anterior mesenteroaxial rotation, the
antrum comes to lie anterosuperior to the fundus and obstruction is usually in the antropyloric region.
