Honna T, Kamii Y, Tsuchida Y
Department of Surgery, National Children's Hospital, Tokyo, Japan.
J Pediatr Surg. 1990 Jul;25(7):707-10. doi: 10.1016/s0022-3468(05)80001-6.
Gastric volvulus is a rare condition in childhood. Most of the reported cases have been acute and secondary in type with predisposing factors. Between 1965 and 1988, 49 patients were treated at this institution for chronic idiopathic gastric volvulus. Patients were divided further into two groups according to age at admission. The main symptom was vomiting in the neonatal and infantile group, whereas it was abdominal distension, vomiting, weight loss, or constipation in the older age group. This clinical feature was different from that of acute gastric volvulus in which the symptoms resulted from gastric obstruction. Plain film of the abdomen showed no characteristic findings. Contrast study of upper gastrointestinal series showed findings similar to those of the acute volvulus, but the extent or degree was less significant. Conservative treatment was successfully undertaken for the patients in the neonatal and infantile group just by keeping them in prone position. The rationale for this method was demonstrated by the clinical and radiological improvement. Fundic gastropexy was performed in all of 18 patients of the older age group and in one of 31 patients of the neonatal and infantile group. The operative results were satisfactory except for one patient with mental retardation. In Japan, neonates or infants are customarily nursed in the supine position. This is presumed to be a reason why the chronic idiopathic gastric volvulus is frequently noticed.
胃扭转在儿童期是一种罕见病症。大多数已报道的病例为急性且继发类型，存在诱发因素。1965年至1988年期间，该机构共治疗了49例慢性特发性胃扭转患者。根据入院时的年龄，患者被进一步分为两组。新生儿及婴儿组的主要症状为呕吐，而大龄组的主要症状为腹胀、呕吐、体重减轻或便秘。这一临床特征与急性胃扭转不同，急性胃扭转的症状由胃梗阻引起。腹部平片无特征性表现。上消化道造影检查结果与急性扭转相似，但范围或程度较轻。仅通过让新生儿及婴儿组患者保持俯卧位，成功地对其进行了保守治疗。临床和影像学改善证明了该方法的合理性。大龄组的18例患者及新生儿和婴儿组的31例患者中的1例接受了胃底固定术。除1例智力发育迟缓患者外，手术结果均令人满意。在日本，新生儿或婴儿通常仰卧护理。这被认为是慢性特发性胃扭转经常被发现的一个原因。
