Georgacopulo P, Pavanello P, Shweiki F, Guerra D
Ospedale S. Anna, Divisione di Chirurgia Pediatrica, Azienda Ospedaliera, Ferrara.
Minerva Pediatr. 1996 Jun;48(6):275-8.
Gastric volvulus in children might be observed both as an acute form, characterized by gastric necrosis with sudden perforation and patient's death and as an idiopathic or chronic form with a less severe insurgence that causes epigastric pain, vomit and gastric distension. The latter could resolve spontaneously but recurs frequently. The acute form rises in newborns and toddlers and is often associated with a diaphragmatic defect; the idiopathic forms are correlated on the opposite to a fixation deficit of the stomach which is held in place by the gastro-colic, gastro-hepatic, gastro phrenic and gastro-splenic ligaments. Since a diagnostic mistake could cause the patient's death gastric volvulus must be carefully considered as a possible cause of acute epigastric pain with vomit. In the two forms surgical therapy is mandatory for the simultaneous correction of both the anatomical defects of gastric fixation and malposition and the diaphragmatic ones. The case presented is an example of an acute gastric volvulus in a 2-year-old male child affected by a diaphragmatic defect The peculiar aspect of this case consists in the age of arousal being more usual in an earlier age An appropriate surgical treatment has permitted the patient's recovery.
儿童胃扭转既可以表现为急性形式,其特征为胃坏死伴突然穿孔以及患者死亡;也可以表现为特发性或慢性形式,起病较轻微,导致上腹部疼痛、呕吐和胃扩张。后者可自行缓解,但常复发。急性形式多见于新生儿和幼儿,常与膈肌缺损有关;相反,特发性形式与胃的固定缺陷有关,胃由胃结肠韧带、胃肝韧带、胃膈韧带和胃脾韧带固定于正常位置。由于诊断错误可能导致患者死亡,胃扭转必须被谨慎地视为急性上腹部疼痛伴呕吐的可能病因。对于这两种形式,手术治疗都是必要的,以便同时纠正胃固定和位置异常的解剖缺陷以及膈肌缺陷。所呈现的病例是一名患有膈肌缺损的2岁男童急性胃扭转的例子。该病例的特殊之处在于发病年龄在幼儿中更为常见。适当的手术治疗使患者康复。