Volvulus Research Articles

Innovative Approaches to Managing Postoperative Complications in Laparoscopic Sleeve Gastrectomy: A Scoping Review.

Background: Laparoscopic sleeve gastrectomy (LSG) is an effective surgical intervention for obesity, but managing complications post LSG remains crucial. Given the global prevalence of obesity, innovative approaches are needed to improve patient outcomes. Objective: This scoping review aimed to comprehensively map the existing literature on innovative approaches for managing complications in adult patients undergoing LSG to treat morbid obesity. This management strategy may include surgical techniques, perioperative care, nutritional support, or other relevant strategies. Methods: A systematic search of PubMed and Scopus databases was conducted to identify relevant studies. The prespecified inclusion criteria were applied through a two-stage screening process. Studies involving adult patients who underwent LSG for morbid obesity (body mass index > 35) and those investigating interventions related to complications were included. The scoping review process adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. The results were summarized using a narrative approach. Results: This review included 31 studies with 4547 participants, showing diverse study designs, patient demographics, and surgical locations. Among them, 6 were case reports, 18 were randomized controlled trials, and 7 were retrospective studies. Complications of LSG include staple-line leaks, stenosis, hemorrhage, infection, gastric volvulus, and nutrient malabsorption. Innovative interventions, such as staple-line reinforcement, plication methods, and the Over-the-Scope Clip system, have been investigated for effective management. Conclusion: This scoping review provides valuable insights into innovative interventions for managing complications post LSG. This review highlights the need for further research to explore long-term outcomes, compare different interventions, and address the existing gaps in the literature.

A Case of Cecal Volvulus in the Setting of Multiple Sclerosis

A Case of Cecal Volvulus in the Setting of Multiple Sclerosis

Radiographic findings in dogs with 360 degrees gastric dilatation and volvulus.

Gastric dilatation and volvulus (GDV) is a life-threatening emergency that requires urgent intervention. Radiographic features associated with 360-GDV in dogs have not been investigated. The aim of this retrospective observational study is to describe radiographic features and clinical variables in dogs affected with 360-GDV and to report agreement rates between different radiologists. We also report the sensitivity and specificity of radiographs to diagnose 360-GDV in dogs. Confirmed 360-GDV cases were retrieved, and the radiographic findings were compared with dogs presenting with gastric dilatation (GD) and 180-GDV. Images were reviewed and graded by three blinded board-certified radiologists. A total of 16 dogs with confirmed 360-GDV were identified. The median age was 10 years old (2-13 years). The sensitivity for detection of 360-GDV ranged between 43.7% and 50%, and the specificity between 84.6% and 92.1%. Interobserver agreement on final diagnosis was substantial (Kappa=0.623; 0.487-0.760, 95% CI). The highest agreement rate was in cases of 180-GDV (87%), followed by the GD cases (72%) and 360-GDV (46%). Severe esophageal distension and absence of small intestinal dilation were the only radiographic features specifically associated with 360-GDV. A similar pyloric position was found between GD and 360-GDV. Additional radiographic variables that could help differentiate GD from 360-GDV include the degree of gastric distension and the peritoneal serosal contrast. Two cases with 360-GDV were misdiagnosed by the three radiologists as GD. In conclusion, radiographically, 360-GDV cases can reassemble GD and vice versa. Radiologists and clinicians should be aware of the low sensitivity of radiographs for the detection of 360-GDV.

Gastrointestinal involvement in Ehlers-Danlos syndrome: A case series and systematic review

Objective: To explore the clinical and genetic characteristics of patients with Ehlers-Danlos syndrome (EDS) and gastrointestinal involvement. Methods: We retrospectively collected the clinical data of patients with EDS and gastrointestinal involvement from the electronic medical records at Peking Union Medical College Hospital (PUMCH) from January 2003 to September 2023. Additionally, we conducted a systematic review by searching cases with EDS and gastrointestinal involvement in PubMed, Embase, Web of Science, and the Cochrane Library databases from January 2000 to September 2023. Results: Ninety-four patients with EDS and gastrointestinal involvement were retrieved, including five patients from PUMCH and 89 patients from 80 published articles. The average age of patients was (29±14) years. The most common manifestation of gastrointestinal involvement was gastrointestinal perforation (n=46, 48.9%), followed by functional gastrointestinal symptoms (n=33, 35.1%), and digestive arterial disorders (n=10, 10.6%). The most common clinical subtype was vascular-EDS (vEDS) (n=50, 53.2%) followed by hypermobile-EDS (hEDS) (n=20, 21.3%). The most frequent genetic mutation occurred in the COL3A1 gene (n=30, 31.9%). Among patients with vEDS, gastrointestinal manifestations included gastrointestinal perforation (n=33, 66.0%), arterial lesions (n=9, 18.0%), and functional gastrointestinal symptoms (n=7, 14.0%). Among patients with hEDS, gastrointestinal manifestations included functional gastrointestinal symptoms (n=18, 90.0%), visceral prolapse (n=3, 15.0%) and intestinal volvulus (n=1, 5.0%). Conclusions: The most common subtypes of gastrointestinal involvement in EDS were vEDS and hEDS. Patients with hEDS mainly presented with functional gastrointestinal symptoms, whereas those with vEDS primarily showed gastrointestinal perforation and digestive arterial disorders.

S3055 Swirling Strangulated Cecal Volvulus Masked as Small Bowel Obstruction

S3055 Swirling Strangulated Cecal Volvulus Masked as Small Bowel Obstruction

Long-term survival and complications following small intestinal resection and partially stapled, functional end-to-end anastomosis.

The aim of the present study was to investigate the long-term survival and postoperative complications in horses that had undergone small intestinal resection and a modified anastomosis technique using a partially stapled, functional end-to-end anastomosis. Observational retrospective case series. A total of 25 horses underwent small intestinal resection and a partially stapled, functional end-to-end anastomosis. A modified technique to create a partially stapled, functional end-to-end anastomosis is described. The clinical case records of all horses that fulfilled the criteria between January 1, 2010 and January 1, 2020 were reviewed. Data on short-term survival and postoperative complications were collated. A telephone questionnaire of owners was undertaken to evaluate long-term survival. Duration of follow up was from one to 4232 days (median 785 days). A total of 21/25 (84%) of horses survived to discharge, 19/25 (76%) horses were alive at 6 and 12 months and 64% survived to 2 years. A total of 64% of horses developed at least one postoperative complication. Two horses developed a small intestinal volvulus necessitating repeat laparotomy. One horse had kinking at the anastomosis site diagnosed at post-mortem examination. Partially stapled functional end-to-end anastomosis technique in this study had similar short- and long-term survival to those reported in previous studies using handsewn techniques, but severe complications at the anastomosis site occurred in >10% of cases. The anastomosis technique described appears to have similar short- and long-term survival and complication rates, compared to more commonly used anastomosis techniques. However, there is potential for severe complications at the anastomosis site.

A case of isolated malrotation without midgut volvulus diagnosed prenatally and treated by laparoscopic surgery

BackgroundMalrotation is a congenital condition that predisposes individuals to midgut volvulus, which can result in significant bowel resection. While most cases of malrotation are diagnosed by the age of 1 year, typically presenting with symptoms related to volvulus or bowel obstruction, some cases remain asymptomatic. In children with visceral malposition, gastroschisis, omphalocele, or diaphragmatic hernia, malrotation may be suspected before symptoms manifest. However, isolated malrotation without midgut volvulus diagnosed prenatally is rare. We herein present a case of isolated malrotation without midgut volvulus that was prenatally diagnosed and successfully treated with laparoscopic surgery.Case presentationA 30-year-old woman (gravida 3, para 1) underwent routine obstetric ultrasound, which revealed increased blood flow in the lower uterine segment and abnormal placental attachment. To rule out placenta percreta, magnetic resonance imaging was performed at 34 weeks of gestation. Incidentally, abnormal fetal intestinal arrangement was noted, with the colon localized in the left hemi-abdomen and the small intestine distributed in the right hemi-abdomen, raising suspicion of malrotation. Postnatal contrast studies confirmed the diagnosis of malrotation without midgut volvulus. Given the risk of midgut volvulus, a laparoscopic Ladd’s procedure was performed on day 6 of life. The postoperative course was uneventful, and the patient was still symptom-free 1 year postoperatively.ConclusionsThis case illustrates that malrotation can be prenatally diagnosed using fetal magnetic resonance imaging. Considering the risk of midgut volvulus, prophylactic Ladd’s procedure should be performed in neonatal period. In cases where malrotation is not complicated by midgut volvulus, a laparoscopic Ladd procedure can be safely performed in neonates.

Serial Transverse Enteroplasty (STEP) for Short Bowel Syndrome (SBS) in Children: A Multicenter Study on Long-term Outcomes

ObjectivesShort Bowel Syndrome (SBS), secondary to various underlying diseases, is one of the main causes of intestinal failure in children. Surgical management by serial transverse enteroplasty (STEP), is feasible in selected cases, but results on long-term follow-up are scarce. The aim of this study was to report long-term outcomes of the STEP procedure in children with SBS. MethodsWe performed a multicenter national retrospective study reviewing medical charts of children who underwent a STEP technique between 2000 and 2022 in 6 university hospitals. Collected data included demographics, SBS history, surgical procedures, nutritional support (enteral or parenteral), STEP management, complications, and outcomes (nutritional support, digestive symptoms, growth). ResultsSTEP was performed in 36 SBS, resulting from 14 gastroschisis, 10 intestinal atresia, 8 necrotizing enterocolitis (NEC), 2 midgut volvulus, and 2 intestinal Hirschsprung disease. Median age at first STEP was 10.8 months [4.5; 63.8]. Bowel length significantly increased (47 vs 70 cm, p < 0.01), with a median gain of 16 cm [11; 25] or 34%. At surgery, 33 children had parenteral nutrition (PN). A second STEP was performed in 11 patients, at a median age of 4.2 years [2.8; 6.8]. One patient underwent a third STEP. Two children required intestinal transplantation. Median follow-up was 7 years [4.4;11.4]. Out of 33 children requiring PN before surgery, 14 children were weaned off PN. The remaining 19 children still required PN, but their dependency decreased by 19%. Out of 17 children presenting severe intestinal dilations and bacterial overgrowth, 12 became asymptomatic. Out of 20 with chronic obstructive symptoms, 8 patients still required supplementary PN whereas 12 achieved complete enteral autonomy, including 3 requiring supplementary enteral support. ConclusionSTEP technique remains a surgical option in the management of these children, enabling a decrease in PN dependency, resulting in weaning off PN in some cases, as well as an improvement of clinical symptoms. Type of StudyRetrospective multicenter observational study. Level of EvidenceLevel 3.

Debating and Expanding on the Midgut Volvulus Case: A New Perspective

Since midgut volvulus is a rare but serious condition featuring twisted intestines, this presents significant problems with diagnosis and treatment- especially for adults. Early diagnosis and swift action are important in preventing such complications as juxtaposition of the bowel loops with volvulus, necrosis, etc. This study is based on recent developments of a case documented in then Jordanian American Physicians Academy Journal, and makes clear the difficulties involved in diagnosing midgut volvulus in a patient with cavernous transformation of the portal vein. Entering oublic health and reaching out to each discipline, means T.The fact that this study involved adult and pediatric cases demonstrates the need for advanced imaging technology and individualized treatment plans in order to improve patient outcomes.

Gastric Volvulus in Association with Bockdalekhernia in Adult Patient (Case Report)

Purpose: Bochdalek hernia (BH) in adulthood is rare. Symptomatic BH in adults is rarer, but may lead to fatal complications. Patients with acute gastric volvulus on diaphragmatic hernia are a diagnostic and therapeutic emergency.Materials and Methods: A 22-year-old male patient presented to our emergency department with a two-day history of severe epigastric pain. The pain was dull in nature with dyspnea on lying supine. Findings: The stomach was within the thorax on the left side due to left diaphragmatic hernia of a nontraumatic cause, diagnosed by chest radiograph, and computed tomography (CT). The patient was prepared for the open surgical repair, to close the defect. The patient recovered with accepted general condition and was discharged 5 days later. In conclusion, in our case, we report this rare presentation of BH with gastric volvulus as an urgent condition that needs to be diagnosed as early as possible to prevent fatal complications. Implications to Theory, Practice and Policy: A diagnosis of an adult diaphragmatic hernia should always be kept in mind in patients with overlapping abdominal and respiratory symptoms with or without a history of trauma.

Intestinal malrotation with levocardia and Spondylo-costal dysostosis: A case report

Background: Intestinal malrotation with midgut volvulus is usually present in the neonatal period but can present at any age, and can be associated with various congenital anomalies. These congenital defects increase the morbidity of the disease per se and require a multidisciplinary approach. Case Presentation: The index case was an eight-month-old child with intestinal malrotation, situs inversus, levo-cardia, single ventricle, and Spondylo-costal dysostosis. Here, we discuss its presentation, treatment, challenges during management, and review of pertinent literature. Conclusion: The association of intestinal malrotation with situs inversus, levocardia, and SCD requires further reporting as well as genetic studies to understand its embryo pathogenesis. The multidisciplinary team is essential for the ideal treatment of this type of complex case.

Laparoscopic Type IV Hiatal Hernia Repair in the Elective and Emergency Settings, Clinical Presentation, Outcomes, and Same-Day Surgery in Elective Repairs

Objective: We aimed to compare the outcomes of laparoscopic type IV hiatal hernia repairs in elective and emergent settings and assess the feasibility of same-day surgery (SDS) in elective repairs. Methods: SDS was defined as discharge on the day of the procedure. The feasibility of SDS in elective repairs was assessed. Results: There were 265 primary type IV hernia repairs: 208/265 (78.5%) elective versus 57/265 (21.5%) in emergent settings, age:70.0 (64.0-75.0) versus 73.0 (60.8-82.0), P = .059, BMI: 30.1 (26.6-33.8) versus 27.5 (24.4-32.4), P = .025, ASA IV: 5/208 (2.4%) versus 11/57 (19.3%), P &lt; .001, LOS:1 (0-2) versus 2 (1-4), P &lt; .001, 30-day mortality: 0/208 (0.0%) versus 2/57 (3.5%), P = .046. SDS was planned in 83/208 (39.9%) elective procedures and performed in 65/83 (78.3%); 18/83 (21.7%) were transitioned from SDS to observation/inpatient. NGT was attempted in 18/57 (31.6%) in emergent setting and was successful in 5/5 at the bedside and 11/13 (84.6%) endoscopically. Ischemia was seen in 4/57 (7.0%) in emergent settings and perforation in 1/4. Time from surgical consultation to arrival to the OR in patients without ischemia/perforation/obstructive gastric volvulus (n = 50) was 57.9 hours (44.0-79.7) versus 5.5 hours (4.1-8.9) in those with, (n = 7). Conclusion: Type IV hiatal hernia can be repaired laparoscopically with good outcomes in elective and emergent settings and as SDS in elective repairs. Emergent presentations can occur in about 20% of type IV hernias in older patients with lower BMI and higher ASA. Ischemia/perforation are rare. Emergent presentations without ischemia/perforation can be treated with gastric decompression and urgent repair during the same admission.

Performance of Prenatal Ultrasound Screening for the Relative Positioning of Mesenteric Vessels.

Abnormal relative positioning of the superior mesenteric artery (SMA) and vein (SMV) can lead to intestinal malrotation that predisposes to midgut volvulus. The aim of this study was to assess the prenatal ultrasound ability to visualize the relative position of SMA and SMV in normal pregnancies. Prospective cohort study performed in Montpellier University Hospital Centre, including 80 fetuses during routine 3rd trimester ultrasound scan. For each fetus included, the relative position of the vessels on an axial image was defined as SMV on the right, forward, or on the left of SMA. Doppler imaging was additionally used if necessary. Data were compared to the neonatal abdominal scans performed by pediatric radiologist. The superior mesenteric vessels were identified in 79 fetuses. Prenatal findings showed a usual relative position of the vessels, that is, the vein on the right of the artery, in 96.2%. In 2 cases, the vein was strictly in front of the artery, and in 1 case, the vein was on the left side of the artery. Seventy-four neonates were examined and comparison with prenatal finding showed a perfect agreement (Kappa coefficient of 100%). An intestinal malrotation was postnatally diagnosed corresponding to the case where vein was on the left side of the artery. This study showed that the relative position of the SMA and SMV could be assessed using ultrasound prenatal examination with a perfect agreement with postnatal findings. In case of abnormal vessels positioning more examinations should be promote including prenatal MRI and postnatal conventional radiologic examinations to confirm intestinal malrotation.

MOY 1 - The Emergency General Surgeon: what should their future operative role be, and how can an EGS post be more attractive?

Abstract Aims Determine the desired future operative role of dedicated Emergency General Surgery (EGS) surgeons in the United Kingdom (UK) and the Republic of Ireland (ROI), and how to improve the attractiveness of an EGS post. Methods A live interactive online survey, designed and endorsed by ASGBI, was completed by attendees at two ASGBI conferences in 2023. The study was conducted according to CHERRIES and exempt from REC according to HRA. Consent was obtained from study participants, who were asked using a Likert scale which operations a dedicated EGS surgeon should perform and how an EGS post could be more attractive. Results The survey was completed by 156/371 eligible participants, of which 132 responses were analysed once duplicate responses (n=16), and non-UK/ROI respondents (n=8), were excluded. Participants included consultants (34%), surgical trainees (42%), and other doctors (23%), 61% were male and 39% were female, aged between 25 and 69. Respondents stated the desired future operative role of EGS surgeons included most EGS operations, including for torso trauma. Few believed EGS surgeons should perform emergency colonic resection for cancer (49%) or inflammatory bowel disease (37%), gastric volvulus (34%), bariatric complications (26%), or Boerhaaves (28%). The vast majority agreed that EGS posts could be improved by including elective general and subspecialty operating lists, continuing professional development, minimally-invasive (laparoscopic/robotic) opportunities, rest days post-on-call, family-friendly hours, EGS ambulatory and follow-up clinics, and major trauma responsibility. Conclusions EGS surgeons should operate on the majority of EGS patients. Job plans that include elective operating, professional development, and patient follow-up may improve recruitment and retention.

WP4.19 - The Emergency General Surgeon: what is their current operative role?

Abstract Aims Determine the current operative role of dedicated Emergency General Surgery (EGS) surgeons in the United Kingdom (UK) and the Republic of Ireland (ROI). Methods A live interactive online survey, designed and endorsed by ASGBI, was completed by attendees at two ASGBI conferences in 2023. The study was conducted according to CHERRIES and exempt from REC according to HRA. Consent was obtained from study participants, who were asked which surgeons usually perform the most common EGS operations in their hospital. Results The survey was completed by 156/371 eligible participants, of which 132 responses were analysed once duplicate responses (n=16), and non-UK/ROI respondents (n=8), were excluded. Participants included consultants (34%), surgical trainees (42%), and other doctors (23%), 61% were male and 39% were female, aged between 25 and 69. The general surgeon on-call – or a dedicated EGS surgeon, where such service exists – operates on the majority of EGS pathology through an un-selected take. A surgeon with the relevant sub-specialty interest usually operates on emergency non-traumatic complex upper gastrointestinal or colorectal pathology. These include emergency colonic resections for cancer or inflammatory bowel disease, and operations for gastric volvulus, bariatric complications, and Boerhaaves. Acute cholecystectomy forms a major part of a dedicated EGS surgeon’s practice. Conclusions Dedicated EGS surgeons deliver a wide variety of operations, in addition to the peri-operative management of acute surgical patients. Future curriculum design and NHS workforce planning should reflect this service delivery pattern, should EGS become a recognised specialty interest.

The Ratio of Remaining to Expected Small Bowel Length Predicts Enteral Autonomy in Pediatric Patients with Short Bowel Syndrome

BackgroundPediatric patients with short bowel syndrome (SBS) often require long-term parenteral nutrition and intravenous fluid support (PN) until enteral autonomy (EA). However, long-term PN accounts for many complications. We aimed to investigate the outcome and predictors of EA in these patients. Material and MethodsThis retrospective observational study was conducted in Children’s Medical Center, Chang Gung Memorial Hospital, a tertiary hospital in Northern Taiwan. Twenty-four patients afflicted with short bowel syndrome between 2002 and 2021 were included. Demographics, operation results, follow-up status, complications, and outcomes were reviewed. ResultsAmong the 24 patients, 14 were males (58%). The median age at bowel resection was 3 days (IQR, 1.3 to 28.8 days). The most common etiologies were total/subtotal intestinal aganglionosis (TIA) (N=6) and malrotation with midgut volvulus (N=6). The median length of the residual small intestine was 25cm (IQR, 7.8 to 71.3cm). Ten (41.7%) had preserved ileocecal valve, and 14 (58.3%) had colon-in-continuity. Intestinal failure-associated liver disease (IFALD) occurred in 14 patients (58.3%), but none had advanced disease. Seven (29.2%) patients achieved enteral autonomy after 10.1±7.3 months. Five patients (21%) expired due to sepsis. Logistic regression and Kaplan-Meier analysis showed the predictors of enteral autonomy were remaining-to-expected small bowel length ratio > 25% and the absence of IFALD. ConclusionsIn this pediatric short bowel syndrome study, enteral autonomy was achieved in 29% after a mean PN duration of 10 months. The remaining-to-expected small bowel length ratio at bowel resection was the most critical predictor of enteral autonomy.

498. LATROGENIC ESOPHAGEAL DISEASE POST OBESITY TREATMENT: SEVERE ESOPHAGEAL DILATATION RELATED TO ADJUSTABLE GASTRIC BANDING (AGB)

Abstract Iatrogenic Esophageal Disease post obesity treatment: severe esophageal dilatation related to adjustable gastric banding (AGB) Introduction Obesity is considered one of the biggest epidemics of the 21st century, which pushes us as health professionals to seek for solutions to this pathology. Within the medical-surgical approach, the most used techniques are gastric bypass, vertical gastrectomy and adjustable gastric banding (AGB). Even though they are frequently used, they are not free of complications. In this communication based on a case we would like to comment on the main complications of the use of the gastric band. These side effects has being between 0.5-5% to 20%: stoma stenosis, band slippage, intraluminal erosion, gastric volvulus and perforation. Clinical Case 54-year-old woman underwent surgery 20 years ago for obesity using a restrictive technique with adjustable gastric banding. The patient began 18 years later with retrosternal pain, epigastric pain, vomiting and dysphagia. Endoscopic tests revealed esophageal dilation with retention of food remains, tortuous and macerated mucosa; said achalasia was caused by a gastroesophageal stenosis. Among the diagnostic tests, an esophageal-gastric-duodenal barium transit was performed, showing a decrease in peristalsis with diffuse esophageal dilation of up to 7cm in diameter. Stenosis was observed in the lower esophageal third at the level of the esophagogastric junction of approximately 16 x 11 mm in longitudinal and transverse diameters. Evolution Surgical removal of the device is decided by a multidisciplinary team. Laparoscopic release of the gastric band was performed with electrocautery following adhesions around the device. Complete withdrawal upon release. Intraoperative endoscopy was performed, showing significant esophageal dilation with retained fermented food remains, mucous membrane affected by esophageal candidiasis. After the esophagogastric junction, a gastric fibrous ring was evidenced at the place of location of the gastric band, with good passage without evidence of gastric or esophageal lesions. Favorable postoperative evolution, being discharged 24 hours after surgery. After the case we observed the failure of the safety mechanism of the gastric band that regulates the internal diameter of the device due to the formation of a fibrotic constriction ring. Removal of the device improves the symptoms without requiring, in this case, section of the constriction ring. Currently, the patient shows improvement in her symptoms 6 months after the bariatric revision surgery.

Complex Hiatal Hernia with Gastric Volvulus Successfully Managed by Hiatal Plasty and Nissen Fundoplication: A Case Report

Background: Hiatal hernias, particularly those complicated by gastric volvulus, represent a rare but potentially life-threatening condition. Prompt diagnosis and surgical intervention are crucial to prevent severe complications such as strangulation and ischemia of the stomach. This case report details the presentation, diagnosis, and successful surgical management of a Type IV hiatal hernia with an associated gastric volvulus using hiatal plasty and Nissen fundoplication. Case Presentation: We present the case of a 65-year-old male with a history of recurrent epigastric pain, nausea, and postprandial vomiting, who was diagnosed with a Type IV hiatal hernia complicated by an organoaxial gastric volvulus. Imaging studies confirmed the diagnosis, revealing significant herniation of the stomach into the thoracic cavity. The patient underwent elective surgical repair involving a hiatal plasty to restore the diaphragmatic hiatus, followed by a Nissen fundoplication to prevent recurrence. Postoperative recovery was uneventful, with resolution of symptoms and no recurrence at a six-month follow-up. Conclusion: This case underscores the importance of timely recognition and appropriate surgical management of hiatal hernias complicated by gastric volvulus. The combined approach of hiatal plasty and Nissen fundoplication provides effective relief and prevents recurrence, contributing to favorable long-term outcomes.

Prenatal scan saves lives: Jejunal atresia with midgut volvulus: A case report

Prenatal scan saves lives: Jejunal atresia with midgut volvulus: A case report

Gastric volvulus in children: diagnosis and treatment approaches

Gastric volvulus is a sporadic disease in the pediatric age group and is very complex in terms of etiology and management. In this study, we aimed to discuss two late-diagnosed gastric volvulus cases, review the diagnosis and treatment methods of gastric volvulus cases in the pediatric age group encountered in the literature, and reduce concerns about the correct diagnostic approach to these cases. The first case was an 8-year-old girl who was followed up due to developmental delay and metabolic disease and was admitted due to recurrent vomiting attacks. The endoscopic reduction was first performed on the patient whose upper gastrointestinal tract imaging was compatible with organoaxial gastric volvulus. Since vomiting attacks continued, laparoscopic gastropexy was performed. In the postoperative follow-up, there was weight gain and vomiting complaints wholly regressed. The second case was a 1-year-old girl who was treated for gastroesophageal reflux at an external center due to vomiting and developmental delay, but she did not receive any response. The endoscopic reduction was performed because the patient's upper gastrointestinal imaging was compatible with the organoaxial gastric volvulus. Laparoscopic gastropexy was performed on the patient whose vomiting recurred. The stomach was expected to be seen in the upper passage imaging in the postoperative period. In the systematic search made in the MEDLINE/Pubmed database using the keywords "gastric volvulus and pediatric," 41 literature articles presenting 47 cases between 2013 and 2023 were included. The patient's age, gender, complaints at admission, type of gastric volvulus, and treatment-related data were collected. The most common symptoms in the patients were vomiting, and abdominal pain and the most common comorbidities were diaphragmatic pathologies and wandering spleen. The most preferred treatment was anterior gastropexy. Gastric volvulus is characterized by vomiting, abdominal pain, and developmental delay. It is tough to diagnose, especially in chronic cases. In addition to the conservative approach in chronic cases, anterior gastropexy should be preferred to prevent recurrent volvulus attacks.