title: Gastric volvulus in children: the twists and turns of an unusual entity.
abstract: BACKGROUND
  Gastric volvulus in children is uncommon, and characteristic radiographic findings might not be recognized.
  
  
  OBJECTIVE
  To present the spectrum of clinical and imaging findings, correlate the type of gastric volvulus with clinical outcome, and identify imaging findings to aid in early diagnosis.
  
  
  METHODS
  Medical records and imaging findings of ten children with gastric volvulus were reviewed. Imaging included abdominal radiographs, upper gastrointestinal (UGI) series, and CT. The diagnosis (organoaxial, mesenteroaxial or mixed type) was made on the UGI series (n = 9) and CT (n = 1), and confirmed surgically in seven children.
  
  
  RESULTS
  Patients were classified based on presentation: four acute, four chronic, and two neonatal. All of the acute group (three mesenteroaxial and one mixed type) had abnormal radiographic findings: three spherical gastric distension, four paucity of distal gas, three elevated left hemidiaphragm, one overlapping pylorus and gastric fundus, one unusual nasogastric tube course, and one situs inversus. All underwent emergent surgery. Three had diaphragmatic abnormalities. One had heterotaxy. Patients in the chronic group (three organoaxial, one mesenteroaxial) had long-standing symptoms. Most had associated neurologic abnormalities. In the neonatal group, organoaxial volvulus was found incidentally on the UGI series.
  
  
  CONCLUSIONS
  A spectrum of findings in gastric volvulus exists. Mesenteroaxial volvulus has greater morbidity and mortality. Radiographic findings of spherical gastric dilatation, paucity of distal gas and diaphragmatic elevation are suggestive of acute volvulus, particularly in patients with predisposing factors.
authors.affiliation: Department of Radiology, Children's Hospital at Montefiore Medical Center, 111 East 210th St, Bronx, NY 10467, USA. soh@montefiore.org
authors.forename: Sarah K
authors.initials: SK
authors.lastname: Oh
authors.forename: Bokyung K
authors.initials: BK
authors.lastname: Han
authors.forename: Terry L
authors.initials: TL
authors.lastname: Levin
authors.forename: Robyn
authors.initials: R
authors.lastname: Murphy
authors.forename: Netta M
authors.initials: NM
authors.lastname: Blitman
authors.forename: Carmen
authors.initials: C
authors.lastname: Ramos
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011860:Radiography, Abdominal; D012189:Retrospective Studies; D013277:Stomach Volvulus / Q000145:classification / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed