Gastric Volvulus in Infancy Presenting

  With Pneumonia and Respiratory Distress

  Mohammad H. Soltanzadeh , MD,ID

        Professor of Pediatrics,  Shaheed  Beheshti  University

         Of Medical Sciences  , Tehran , IRAN

  Manouchehr Davaie MD

         Professor of Surgery  , Shaheed Beheshti University

         Of Medical Sciences, Tehran , IRAN


Gastric volvulus is an uncommon condition more so in the Pediatric age group . The cause of gastric volvulus may be idiopathic or secondary to various congenital or  acquired condition .In this study an 4-months old girl infant was admitted for pneumonia and high fever and respiratory distress and agitation Plain film and  upper GI confirmed the diagnosis of gastric volvulus with left – hemi diaphragmatic defects was treated successfully with surgical intervention .

Key Words : Gastric  Volvulus, Diaphragmatic defects , Organoaxial volvulus , Mesantroaxial volvulus.


Gastric volvulus is a rare condition. Over 300 cases have been reported since Berti first recognized this condition in 1866, most of these were in adults (1)

Review of literature has revealed 116 cases in infants and children up to 1994 (2)

In this condition , acquired torsion of stomach results in partial or complete obstruction  of its openings and interruption of the blood supply .Early diagnosis and prompt  surgical intervention are   required to avoid possible complications.


An 4-months old girl infant was admitted to the Pediatrics Ward in Imam Hossein Medical Center for pneumonia and high fever and.  Respiratory distress  and agitation. Abdominal distention and cyanosis frequently occurred after feeding .History of infant shows one week before admission she received Antibiotic due to pneumonia.  She was delivered by normal vaginal delivery .  Her birth weight  was 1750 gr. She admitted to Hospital After birth  due to cyanosis and respiratory distress about 10 days . After discharge at time breast feeding she had cough and dyspnea and cyanosis . History of epigastric distention on and off after feeds. Routine vaccination has been done properly. Physical examination had decreased breathing sounds in left hemi thorax and fine crackle no other finding  was noted in other side .  Mild Fullness in epigastrum and left hypochondrium  T. 39/4c PR 170 RR 65 BP Normal . Labotory finding : ESR Normal  CBC and Diff Normal Hb .11 CRP negative FBS, BUN, Electrolyte, Ca. and ABG about Normal Blood Culture was Negative .

Chest X Ray and Upper GI series demonstrated  left postro- lateral Diaphragmatic Hernia . Spleen and stomach had herniated up with Organoaxial Volvulus of stomach. Gastric Volvulus with left Hemi Diaphragmatic eventration .Diaphragmatic defects placation  made a smooth recovery .


Gastric volvulus is defined as an abnormal rotation of the stomach of 180 degree  of one part of the stomach around another (3) The normal stomach is fixed and prevented from abnormal rotation by the four gastric ligaments .  A normal diaphragm also serves to prevent abnormal displacement of abdominal  viscera and gastric vovulus . ligamentous laxity , pyloric obstruction leading to chronic gastric dilatation, hiatus hernia. Other diaphragmatic hernias, eventration of diaphragm .

Abnormality of the suspensory ligament of the stomach : gastrohepatic , gastrosplenic , gastrocolic , gastrophrenic usually long gastrocolic and gastrohepatic mesentery classified as one of two types : Organoaxial or Mesenteroaxial.(4)

Organoaxial ; Twist occurs along a line connecting the cardia and the pylorus – the luminal (long) axis of the stomach. The antrum rotates in opposite direction to the fundus of the stomach. Most common type , usually  associated with diaphragmatic  defects , vascular compromise more common . Strangulation and necrosis commonly occur with the type and have been reported in 5-28% of cases.


Mesentroaxial ; Twist occurs arounds a plane perpendicular to the luminal (long) axis of the stomach from lesser to greater curvature, The antrum rotates anteriorly and superiorly so that the posterior surface of the stomach lies anterior . chronic symptoms more common . Diaphragmatic defects less common.The rotation are usually incomplete and occurs intermittently. Vascular compromise uncommon.


The clinical symptoms; depend on the extent or degree of rotation and obstruction in acute gastric volvulus . Time and need of surgical intervention always determined by the evidence of vascular compromise . Severe epigastric pain and distention , violent unproductive retching and inability to pass a NG tube compromises the classical tiad of Borchardt (5)  . If vascular compromise occurs, there is 30% mortality rate. The features result from obstruction at the cardia and / or pylorus . Sawaguchi has attributed vomiting in young infants to the mal development of hiatal function (6) . According to etiology ; gastric volvulus can be classified as either type 1 ( idiopathic ) type 2 (congenital or acquired ) . 

Imaging findings ; Massively dilated stomach in LUQ possibly extending into chest . Inability of barium to pass into stomach ( when  obstructed ). Frontal radiograph from an upper GI examination shows the stomach located in the lower chest in a large hiatal  hernia . The greater curvature of the stomach lies superior to the lesser curvature in an organoaxial twist . In the cases of mesentroaxial volvulus , gastric shadow may show double air fluid levels in erect position  with a characteristic beak, one the fundus and the other in the antrum . In organoaxial type , the stomach lies rather horizontally on plain film with single fluid level without the characteristic beak.

Acute gastric volvulus is a surgical emergency as delay in recognition and treatment  can cause strangulation and perforation of stomach.(7) .

In this case ; gastric volvulus with left hemi- diaphragmatic  eventration. Diaphragmatic defects placation made  as stomach recovery.


1-      Berti A. Sigolar altorti glamento dell esofagocol dudeno segitto da rapid morte . Gazz Med Ital prov ver 1866 ; 9: 139

2-      Amin M, Ei-Gohary , Atif Etiaby. Gastric volvulus of the stomach. Am J Surg Int 1994 ; 9:486-488

3-      Tanner NC. Chronicand recurrent volvulus of the stomach.Am J Surg 1968; 115: 505-515

4-      KamPui Fung. Gastric volvulus complicating Nissen’s fundoplication J Pediatr Surg1990 ; 25: 1242-1243

5-      Borchardt M. Kur Pathologie and therapie des magen volvulus . Arch Kin Chir 1904; 74: 243-260

6-      Sawaguchi S, Ohkawa H Kanmotsutt: Idiopathic gastric volvulus in infancy and childhood . Z.Kinderchir 1981;32 : 218-233

7-      Bahasin DK,Nagi B ,Kochhar R Endoscopic management of chronic organoaxialvolvulus of the stomach. Am J Gastroenterol 1990 ; 85: 1486-1488


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