Department of Pediatric Surgery and Pediatric Minimally Invasive Surgery and New Technologies, San Bortolo Hospital, Vicenza, Italy.
J Laparoendosc Adv Surg Tech A. 2022 Aug;32(8):913-919. doi: 10.1089/lap.2021.0836. Epub 2022 Jun 6.
Gastric volvulus (GV) is a rare and life-threatening condition if not promptly diagnosed and treated. Extreme rotation can cause obstruction cutting off blood supply to stomach and distal organs, leading to ischemia and necrosis. It is a clinically significant cause of acute/recurrent abdominal pain and chronic vomiting in children. GV can be classified into the following: primary, secondary, organoaxial, mesenteroaxial, or combined, acute, or chronic. Six neonates (5 males-1 female) were admitted to our department for recurrent postprandial vomiting associated with paleness, hyporeactivity, transitory abdominal distension, failure to thrive, and respiratory infections (only-1). Median age: 6 months (range 2-9 months). Patients metabolic and neurological evaluations were normal. A barium-swallow-study (upper gastrointestinal [UGI]) allowed definitive diagnosis. UGI and esophagogastroduodenoscopy (EGDS) showed a gastric abnormal dilatation (gastric fundus), hiatal hernia (HH) in 5 patients, a large/small curvature discrepancy in 3 patients. Four were chronic-organoaxial-GV, 2 chronic-mesenteroaxial-GV. All underwent Laparoscopic-Hill-Snow-gastropexy (LHSG) with HH correction. No intraoperative/postoperative complications were recorded. Refeeding started in first postoperative day. Average hospital stay: 6-days. At long-term follow-up, all patients were symptoms free (able to vomit/burp); 2 referred occasionally epigastric pain sometimes with vomit. At 10-12 years follow-up UGI and EGDS confirmed correct gastric position revealing gastroduedenitis. GV is a rare clinical entity in children considering etiology and management with an important morbidity and mortality rate. Its diagnosis could be missed simply. Vomiting or HH on imaging studies should suggest GV regardless patient's stable appearance. Chronic GV can manifest with atypical chest, abdominal, and gastrointestinal symptoms. Early diagnosis and treatment reduce the risk of developing acute form. LHSG is a long-term effective and safe solution with a very low complication rate, and no symptoms correlated to Nissen procedure.
胃扭转（GV）是一种罕见且危及生命的疾病，如果不能及时诊断和治疗。极度扭转可导致胃和远端器官的血液供应受阻，导致缺血和坏死。它是儿童急性/复发性腹痛和慢性呕吐的重要临床原因。GV 可分为以下几类：原发性、继发性、器官轴性、肠系膜轴性或混合性、急性或慢性。六名新生儿（男 5 名-女 1 名）因餐后反复呕吐伴苍白、反应迟钝、短暂腹胀、生长发育不良和呼吸道感染（仅 1 名）而入住我院。中位年龄：6 个月（范围 2-9 个月）。患者的代谢和神经评估正常。上消化道造影（UGI）钡餐检查可明确诊断。UGI 和食管胃十二指肠镜（EGDS）显示胃异常扩张（胃底），5 例患者存在食管裂孔疝（HH），3 例患者存在大/小曲率差异。4 例为慢性器官轴性-GV，2 例为慢性肠系膜轴性-GV。所有患者均行腹腔镜下希尔-斯诺胃固定术（LHSG）加 HH 矫正。无术中/术后并发症。术后第一天开始喂养。平均住院时间：6 天。在长期随访中，所有患者均无症状（能够呕吐/打嗝）；2 例偶尔出现上腹痛，有时伴有呕吐。10-12 年随访时 UGI 和 EGDS 证实胃位置正确，胃十二指肠炎症。GV 在儿童中是一种罕见的临床实体，其病因和治疗方法具有重要的发病率和死亡率。其诊断可能会被忽视。无论患者外观是否稳定，影像学检查上的呕吐或 HH 均应提示 GV。慢性 GV 可表现为不典型的胸部、腹部和胃肠道症状。早期诊断和治疗可降低发展为急性的风险。LHSG 是一种长期有效且安全的解决方案，并发症发生率极低，与 Nissen 手术无关的症状。
