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.
