1. Pediatric Gastric
Volvulus
Rebecca Starr, D.O.
PICU Review
4/8/14

2. What is Gastric Volvulus?
• Twisting of all or a portion of the stomach at least 180° about an axis that causes an
obstruction of the foregut
• Rare in children
• Acute, intermittent, recurrent, or chronic
• Acute gastric volvulus
• Life- threatening occurrence
• Good outcome when treated quickly
• Chronic volvulus may be more difficult to recognize

3. Anatomy Review

4. Volvulus Etiology
• Ligament abnormalities
• Abnormalities of gastric anatomy or gastric function
• Abnormalities of adjacent organs
• Diaphragm
• Spleen
• Transverse colon
• Intestines
• Liver

5. Organoaxial Gastric Volvulus

6. Mesenteroaxial Gastric Volvulus

7. Combined Gastric Volvulus

8. Most Common Pediatric Presentation
• Child <5 years old
• Nonbilious emesis
• Epigastric distention
• Abdominal pain

9. Acute vs Chronic

10. Diagnosis and Treatment
• Definitive diagnosis- upper GI
• Definitive therapy- repair of associated defects and anterior fixation of the
stomach to the abdominal wall
• Surgical repair- mortality rate 5%
• Simple reduction
• Open or laparoscopic gastropexies
• Gastrostomy-tube placements
• Fundoplications

11. Mortality Rates
• Acute volvulus- 7%
• Chronic volvulus- 3%
• Nonsurgical chronic volvulus management- 0.8%

12. References
• Cribbs RK, Gow KW, and Wulkan ML. Gastric volvulus in infants and
children. Pediatrics. 2008; 122:752-762.