The intermittent and variable features of gastric volvulus in childhood

Acute gastric volvulus (GV) is a rare pediatric emergency that requires prompt surgical detorsion and gastropexy. In order to clarify the clinical and radiologic features of GV, we reviewed eight cases seen over the past 7 years. The symptoms could be classified as acute, chronic, or intermittent, and included a spectrum of gastrointestinal (GI), respiratory, and nonspecific symptoms. When GV was acute or intermittent, the diagnosis was made on the characteristic appearance of plain abdominal radiographs, whereas in chronic GV an upper GI series was most useful. Endoscopy confirmed or suggested the diagnosis in four cases of intermittent or chronic volvulus. Anterior gastropexy was performed in five patients, gastrostomy in two, and gastroduodenostomy in one. None have recurred over 1 to 7 years of follow-up. Intermittent GI or respiratory symptoms of GV may make the diagnosis difficult. Plain abdominal radiographs, upper GI series, and endoscopy aid the diagnosis. Prompt gastric decompression and anterior gastropexy is the recommended treatment.