Acute gastric volvulus and congenital posterolateral diaphragmatic hernia.
Acute gastric volvulus in infancy is a rare disorder and a surgical emergency. Prompt clinical suspicion and radiological assessment are essential for this life-threatening condition. We report a 3-month-old female case, admitted for an initial suspicion of an intestinal obstruction. She presented unproductive retching, respiratory distress, epigastric distension and lethargy. It was not possible to introduce a naso-gastric tube. A radiological contrast study showed an occluded cardio-esophageal junction without passage of barium, two gastric fluid levels and a horizontally positioned stomach occupying the inferior portion of the left hemithorax, suggesting a left diaphragmatic hernia. Laparotomy revealed an acute mesenterico-axial gastric volvulus with a left posterolateral diaphragmatic hernia. The stomach volvulus was untwisted, the diaphragmatic defect was repaired after reduction of the herniated contents and no gastropexy was done. At 3 and 6-months follow-up examination the infant was asymptomatic and thriving.
Leitão
B
B
Department of Pediatric Surgery, Hospital Maria Pia Porto, Portugal.
Mota
C R
CR
Enes
C
C
Ferreira
P
P
Vieira
P
P
Requeijo
D
D
D000208:Acute Disease; D005260:Female; D006548:Hernia, Diaphragmatic / Q000150:complications* / Q000000981:diagnostic imaging*; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D007223:Infant; D011859:Radiography; D013277:Stomach Volvulus / Q000150:complications* / Q000000981:diagnostic imaging* / Q000601:surgery