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.Keywords: Gastric volvulus, Complications, Paraesophageal hernia, Borchardt’s triad
Highlights
Gastric volvulus is life threatening and needs timely diagnosis and management (1)
We present a fatal case of gastric volvulus to emphasize that clinicians should have a high index of suspicion for this condition even though it is rare, so as to avert its high case fatality rate
Primary, making up a third of cases, is usually due to abnormalities of the gastric ligaments which anchor the stomach and prevent rotation, whereas secondary gastric volvulus is due to other anatomic abnormalities like hiatal or paraesophageal hernia, diaphragmatic eventration, phrenic nerve paralysis or congenital diaphragmatic hernia in children (3)
Summary
Gastric volvulus is life threatening and needs timely diagnosis and management (1). Its peak occurrence is in the fifth decade, and it has no preference for any sex (2, 3). There was no headache, cough, chest-pains, difficulty in breathing, diarrhea, urinary symptoms, wasting or drenching night sweats She had had two previous admissions for malaria but had no history of blood transfusion or surgery. The patient was in respiratory distress, tachypnoiec (60 breaths per minute) and in shock (cold peripheries, weak pulse, heart rate of 164 beats per minute with saturations unrecordable peripherally) Her general exam was unremarkable, but she had reduced air entry over the left lung with no areas of dullness. Gastric volvulus and attendant complications perforations along the greater curvature and hemorrhagic fluid in the left side of the chest cavity. Both lobes of the left lung had collapsed.
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