Gastric volvulus and attendant complications

Abstract

The diagnosis of a hiatal hernia, a gastric volvulus or its attendant complications, can be easily missed because evaluation of acute abdominal pain can be difficult, particularly in resource-limited settings. Diagnosis of a gastric volvulus is even harder in the pediatric population because its peak occurrence is in the fifth decade. Hiatal hernia (and gastric volvulus) can be found incidentally in chest radiographs that are requested routinely or in suspected pulmonary pathology. The gold standard diagnostic tool for a gastric volvulus is a barium swallow. The optimal treatment method is open laparotomy with detorsion, and prevention of recurrence with anterior gastropexy. We present a case of an 8-year-old girl who had a diagnosis of hiatal/paraesophageal hernia with a gastric volvulus complicated by ischemia, necrosis, perforation and collapse of the left lung. A complete history and a thorough evaluation of the sick-looking patient are paramount in diagnosing life-threatening conditions like gastric volvulus.